Social Work Today E-Zine

For generations, social scientists have defined the black middle class in family terms, as married couples with children. But a study from the University of North Carolina at Chapel Hill shows that a growing percentage of the black middle class are young, single people living alone (dubbed the Love Jones cohort in the study). “We’ve dispelled the assumption among scholars that blacks have to be married to be middle class,” says Kris Marsh, PhD, a post-doctoral scholar at UNC’s Carolina Population Center and author of the study, which appears in a recent issue of Social Forces.

Marsh and her colleagues studied United States census data from 1980, 1990, and 2000. The data show that among the black middle class, aged 25 to 44, the Love Jones cohort more than doubled its share between 1980 and 2000, from 5.8% to more than 14%. Meanwhile, the percentage of married couples, living together, with children declined from 64.6% to 48% in that same time period.

By following the data through three decades, the study also confirmed that the Love Jones cohort do not simply delay marriage but remain single and continue to accumulate wealth. This contradicts previous research that said a reduction in marriage and childbearing has created a black middle class in stagnation or in decline. Instead, Marsh says, her work reveals a vibrant population, but the composition is changing.

— Source: University of North Carolina at Chapel Hill

With a $98,000 grant from the Ohio Department of Mental Health, Deborah Akers, Miami University visiting assistant professor of anthropology, is working with Ohio State University‘s Moyee Lee, professor of social work, and Amy Zaharlick, professor of anthropology, on a project to investigate the impact of Tibetan meditation on victims of posttraumatic stress disorder (PTSD). The project will last two years.

Researchers are working with women diagnosed with PTSD who live in a women's treatment program for alcohol and drug addiction. Tibetan monk Geshe Kalsang Damdhul of the Institute of Higher Buddhist Dialectics in Dharamsala, India, will assist as a meditation instructor.

"Participants are being taught specialized meditation techniques and will be guided through meditation for a period of six weeks," says Akers. "This project charts new ground, bringing a holistic perspective to the treatment of PTSD." She adds that though meditation has been used in a variety of therapeutic settings in the West, such as reducing stress and coping with pain, its application in the treatment of mental illness has not been extensively explored.

"Whereas in the West treatment of PTSD may require years of prescription medicine and counseling, the Tibetan approach has been successful within one to two years by focusing on the spiritual connection between the mind and the body that seems to allow the patient to process the trauma more effectively," says Akers.

— Source: Miami University

As the New Year quickly approaches, vows to adopt a healthier lifestyle abound. Health-related New Year’s resolutions top the list of promises American adults make to themselves as the calendar turns every year.

“Sometimes we take on too many changes and create too many goals all at one time,” explains Erica Wright, a licensed clinical social worker and psychotherapist. “Instead of being able to maintain these new habits, we fail because we become overwhelmed.” Many women complain that they are unable to keep their resolutions.

Wright suggests streamlining your resolutions: “Pick one thing versus taking on so many things. For example, quitting smoking is a massive life change that has so many health benefits to it, but choosing to lose weight on top of that is way too much to handle all at once.”

Enacting small and feasible changes may make it easier to incorporate into in already busy lifestyle. Focus on one change at a time. For example, if you want to exercise more, try to work that into your routine before taking on any more challenges. Even if you walk briskly to work, take the stairs instead of the elevator or get to the gym once a week, it can make a difference.

“Perhaps incorporate other goals throughout the year,” says Wright. “It doesn’t necessarily have to get done by January 1.”

— Source: Jennifer Wider, MD, Society for Women's Health Research

Researchers at Cedars-Sinai Medical Center’s Department of Psychiatry and Behavioral Neurosciences are seeking participants for a clinical trial examining whether two polyunsaturated omega-3 fatty acids are effective treatments for depression. The two fatty acids being studied—docosahexanoic acid (DHA) and eicosapentanoic acid (EPA)—are found naturally in fish oil, flaxseed, and walnuts. Previous studies have indicated that nutritional supplements that contain omega-3 fatty acids can be an effective treatment for depression, but this is the first to systematically test the two specific fatty acids in a large sample of people with major depression. DHA and EPA have anti-inflammatory properties and help stabilize brain cell membranes, both of which play a role in mood regulation.

The National Institutes of Health-sponsored study, held in collaboration with Massachusetts General Hospital, will recruit a total of 300 adults aged 18 to 80 who are experiencing significant symptoms of major depressive disorder and are in good health. The five-year study is designed to test the safety, effectiveness, and tolerability of DHA and EPA against each other and a placebo. Participants will receive one of the two drugs or a placebo for eight weeks in a randomized, double-blind manner. The Cedars-Sinai team will examine the effect of the therapies on participants’ symptoms, quality of life and psychosocial function. They will also examine how fatty acids in the blood and proteins involved in immune function are affected by omega-3s.

— Source: Cedars-Sinai Medical Center

Researchers at the University of Pennsylvania School of Medicine report that older adults with diabetes and depression are half as likely to die over a 5-year period when they receive depression care management than depressed patients with diabetes who do not receive depression care management. The first known study to examine the relationship between diabetes and mortality in a depression intervention trial appears in a recent issue of Diabetes Care.

“Depression is common among people with diabetes and contributes to issues with medication and diet adherence, and also leads to an overall reduced quality of life,” says lead author, Hillary R. Bogner, MD, MSCE, assistant professor in the department of family practice and community medicine at Penn.

The multi-site, practice-randomized, controlled trial was conducted in 20 primary care practices in New York City, Philadelphia, and Pittsburgh. A total of 584 participants 60 to 94 years of age were identified through a depression screening, and of these participants, 123 reported a history of diabetes. The practices were randomly assigned to usual care, or a depression care management intervention, which involved a depression care manager who worked with the primary care provider to recommend treatment for depression and assist patients with treatment adherence.

At follow-up, 110 depressed patients had died. Depressed, older adults with diabetes who were in practices randomized to depression care management were less likely to have died at the end of the 5-year follow-up than were depressed, older adults with diabetes who received usual care. The authors note that they believe these findings support the integration of depression evaluation and treatment with diabetes management in primary care.

— Source: University of Pennsylvania School of Medicine

What should a family understand if a child or relative chooses to disclose their sexual orientation during the annual holiday gathering or decides to reveal more about his/her experiences as a gay or lesbian person? Rather than see the news as a ‘bombshell,’ perhaps they should view it as an unexpected gift, says psychologist Robert-Jay Green, PhD. Green is executive director of the Rockway Institute, a national center for science and LGBT public policy at the California School of Professional Psychology, a part of Alliant International University in San Francisco.

Green has conducted original research into the motivations and experiences of gay men as they “come out” to their families, and can draw upon more than 30 years experience as a psychologist in private practice, professor, and researcher to discuss the dynamics of such disclosures for gays and lesbians—and their families.

Among his observations:

• While initial reaction to the news from approximately two thirds of parents is negative, his research shows that, over time, about half of the families experience improved relationships. Another 40% see little change.

• Because males in our culture have the greatest difficulty accepting homosexuality, fathers are often the last in the family to be told. But ironically, the disclosure that a son is gay is likely to have the most positive effect on the father-son relationship over time than on any other relationship in the family.

• While activists tend to encourage all lesbians and gays to ‘come out’ to their families for political reasons, this is not always the best choice for personal or family reasons. A decision not to disclose can be a healthy choice for lesbian/gay people in families where the disclosure could lead to violence, irreconcilable conflict, or to withdrawal of essential economic or other instrumental/emotional support.

• For many lesbians and gay men, ‘coming out’ is an affirmation of self and a signal to relatives that the person values family relationships and wants to honestly share all of his/her life with loved ones. Family members can be helped to view the lesbian/gay person’s act of coming out as a ‘gift’ in which the person shares a significant part of him or herself that has been kept concealed.

• Coming-out is just one step in a much longer journey of being-out. A crucial question for family relations is what happens after the initial disclosure. Too often, the family becomes “frozen-in-time” after the initial coming-out experience, with too few efforts at mutual understanding between family members afterwards.

— Source: Alliant International University

A new brain imaging study by researchers in the Abramson Cancer Center of the University of Pennsylvania shows that cigarette cravings in smokers who are deprived of nicotine are linked with increased activation in specific regions of the brain. This study is the first to show how abstinence from nicotine produces brain activation patterns that relate to urges to smoke. The findings, published in The Journal of Neuroscience, make an important contribution to understanding smoking urges, a key risk factor for relapse, at the brain level.

According to Caryn Lerman, PhD, director of the Transdisciplinary Tobacco Use Research Center and senior author of the paper, and colleagues John Detre, MD, and Ze Wang, PhD, cravings are a hallmark of drug dependence, including nicotine dependence. “There have been several brain imaging studies showing how subjects respond to visual, smoking-related cues, such as a picture of a cigarette or of someone smoking,” says Lerman. “However, less is known about the neural basis of urges that arise naturally as a result of nicotine deprivation. This study was designed help fill this research gap.”

This joint research effort used MRI arterial spin labeled (ASL) technology. ASL measured the cerebral blood flow (CBF) in the brain and compared resting CBF across two scanning sessions that varied by length of periods of abstinence from smoking. Fifteen regular smokers were included in the study. Each participant was scanned in a resting state on two separate occasions: participants smoked a cigarette within an hour of the one scan, and abstained from smoking overnight for the other scan.

The findings indicate that abstinence-induced, unprovoked cravings to smoke are associated with increased activation in brain regions important in attention, behavioral control, memory, and reward. “The craving assessments used in our study predict relapse in smoking cessation treatment,” says Lerman. “If validated in larger studies, these results may have important clinical implications. For example, perfusion MRI may aid in the identification of smokers at increased risk for relapse who may require more intensive therapy.”

— Source: University of Pennsylvania School of Medicine

The number of infants under the age of 2 with HIV who were hospitalized fell by 64% between 1998 and 2005, according to the latest News and Numbers by the Agency for Healthcare Research and Quality (AHRQ). During the same period, hospitalizations for children and adolescents with HIV aged 2 to 17 and for adults with HIV aged 18 to 44 dropped by 41% and 31%, respectively.

Overall, hospitalizations for complications from HIV declined primarily due to life-prolonging protease inhibitor drugs known as the "AIDS cocktail" introduced in 1995. However, life-prolonging drugs may be increasing admissions of older people with HIV who develop other chronic illnesses. AHRQ data found that the rate of hospitalizations rose 43% for patients aged 45 to 54, 61% for those aged 55 to 64, and 56% for Americans aged 65 and over.

This AHRQ News and Numbers is based on data in HIV Hospitalizations in 1998 and 2005. The report uses statistics from the Nationwide Inpatient Sample. The data are drawn from hospitals that comprise 90% of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured. The authors used AHRQ's Inpatient Quality Indicators to determine the in-hospital, risk-adjusted death rates.

— Source: Agency for Healthcare Research and Quality

Older adults at risk for physical disabilities are able to adhere to a regular program of moderate exercise for one year, a recent study of 213 men and women suggests. Led by corresponding author Roger Fielding, PhD, of the Jean Mayer USDA Human Nutrition Research Center on Aging (USDA HNRCA) at Tufts University, the authors observed that improvement in physical function was related to the participants’ ability to adhere to the physical activity regimen.

“At the beginning, middle, and end of the study the participants were tested on their walking speed, strength, flexibility, and balance to gauge their physical function,” says Fielding, director of the Nutrition, Exercise Physiology and Sarcopenia Laboratory at the USDA HNRCA. “We saw a greater improvement in physical function in the participants who reported exercising 150 minutes or more per week.”

The study, published in a recent issue of Medicine & Science in Sports & Exercise, analyzed data from the physical intervention arm of the Lifestyle Intervention and Independence for Elders Pilot. The participants ranged in age from 70 to 89 years old, were sedentary when they enrolled, had health problems such as cardiovascular disease and osteoporosis, and some physical limitations such as difficulty walking or climbing stairs. They followed a moderate exercise program that consisted of walking, strength, flexibility, and balance training.

For the first six months of the study, the participants exercised under supervision at one of four university centers and at home. Center visits were optional during the second six months. The participants filled out surveys to track their adherence to the physical activity regimen during the center visits and at home. The authors observed that physical activity adherence was consistent with earlier studies that followed older adults for shorter durations.

“What we found,” says Fielding, “is that this group can commit to a regular program of physical activity in a long-term, randomized trial and the better their adherence to a program of physical activity the greater their improvements in physical functioning.”

— Source: Tufts University

Upholding the profession of social work’s commitment to human rights and social justice, the National Association of Social Workers (NASW) supports the ability of Guantanamo detainees to challenge their detention through our Constitutional system of government checks and balances.

The cases, Boumediene v. Bush and Al Odah v. United States represent a clear violation of the rights of these detainees to gain access to the courts and to question the legality of their detention. The cases do not directly address the innocence or guilt of the detainees, but rather the circumstances in which they are being held and their access to independent judicial review.

”Social workers uphold the key tenets of the profession—social justice and human rights—by taking a stand against the unchecked use of power by the executive branch,” says Elvira Craig de Silva, DSW, ACSW, NASW president. “We serve as advocates so that everyone may have access to justice and basic legal rights under our Constitutional system of government.”

The NASW Code of Ethics notes that one of the core values of the profession is social justice. To achieve social justice, governments must be able to guarantee access to due process of law.

Habeas corpus is one of the fundamental elements of the U.S. legal system. To strip courts of jurisdiction to review the legality of the detention overrides the detainees’ human rights. Social workers’ abiding concern for social justice and human rights underlies our vision of equal access to justice for all people, regardless of where they are detained and for what reason.

— Source: National Association of Social Workers

In an effort to fill a significant gap in the breast care of underserved women, physicians and nurses at Mayo Clinic’s campus in Jacksonville, FL, developed a program, still ongoing, to help overcome barriers that prevent women from receiving timely care after an abnormal mammogram. From 2001 through 2006, Mayo Clinic’s Multidisciplinary Breast Clinic offered free diagnosis services to 447 women who had been screened for breast cancer by their county health departments in Northeast Florida. The goal was to substantially reduce what can be a long delay between an abnormal screening mammogram and diagnosis—which they succeeded in doing—and thus improve outcomes for the 38 women found to have cancer and reduce distress in many others.

Of the 447 women enrolled through 2006, 65% were white, 21% were black, and 11% were Hispanic. The mean age was 49.7 years. Physicians performed 893 procedures (mostly diagnostic mammograms and ultrasound tests) and found that 90% of the abnormalities detected on initial mammograms were benign. They also diagnosed 38 cancers, of which 76% were invasive carcinoma that needed immediate treatment. In most cases, county health departments provided that treatment, but some patients were cared for at Mayo Clinic. No data is available yet on outcomes.

Many women participating in the program had no address, or just a temporary one, such as a battered women’s shelter, says Frances M. Palmieri, MSN, clinical manager of the Multidisciplinary Breast Clinic. Few had telephones, public transportation to the clinic was nonexistent, and some women were reluctant to come in any case, Palmieri says. Others could not take time away from child care or work to come to the clinic for evaluation. “This is a snapshot of what happens nationally to financially disadvantaged, medically uninsured women,” she says. “We all need to understand and try to overcome the challenges and barriers to patient care that exist for many.

“It is important that women undergo appropriate diagnostic studies as soon as they receive an abnormal breast cancer screening, but it takes much more coordination than we ever expected,” Palmieri adds.

— Source: Mayo Clinic

Although psychiatrists are among the least religious physicians, they seem to be the most interested in the religious and spiritual dimensions of their patients, according to survey data published in the American Journal of Psychiatry. For this paper, the researchers examined results from a survey of 100 psychiatrists and 1,044 nonpsychiatrists from across the United States. Respondents were asked their opinions about the relationship between religion and health and about how they address religious and spiritual issues in their clinical practices.

The researchers found that psychiatrists are twice as likely (46% vs. 23%) as other physicians to say that patients often mention spiritual issues. They are also much more likely to both say that it is appropriate to ask patients about spiritual concerns (93% vs. 53%) and that they do inquire (87% vs. 49%). Psychiatrists were almost twice as likely as other physicians to say that the influence of religion on health is equally positive and negative (21% vs. 12%), and were more likely to say that religion/spirituality sometimes causes guilt, anxiety, or other negative emotions that lead to increased patient suffering (82% vs. 44%).

During a clinical encounter, however, psychiatrists appear to be more comfortable talking to their patients about spiritual issues. They are more likely than other physicians to believe it is appropriate for a physician to discuss such issues when a patient brings them up (97% vs. 91%) and to regularly encourage patients in their own religious ideas and experiences (83% vs. 73%). When patients do bring up spiritual concerns, psychiatrists are less likely to try to change the subject (9% vs. 26%), and they are less likely feel uncomfortable discussing such issues or to be worried about offending patients. Psychiatrists rarely pray with patients, however; only 6% say they do so sometimes, compared with 20% of other physicians.

The results "surprised us," says Curlin. "Among physicians in general, those who are less religious are generally less likely to believe it is appropriate to discuss spiritual issues," he notes. "Yet we find that psychiatrists are at the same time the least religious physicians and the physicians most comfortable addressing patients' spiritual concerns."

— Source: University of Chicago Medical Center

The houseguests are gone. The gifts have been exchanged. The decorations are down, and so are you. If you’re feeling blue following the holidays, you’re not alone. “I see more cases of depression in January than any other time of year,” says Gary L. Malone, MD, the medical director and chief of behavioral health at Baylor All Saints Medical Center at Fort Worth, TX.

The good news is that you can beat your post-holiday blues. Malone offers the following tips:

• Eat, drink and be healthy. Raid your pantry and toss any leftover holiday treats. Eating a balanced diet will give you more energy and will make you feel better. Cut back on caffeine if you’re having trouble sleeping, and limit your alcohol intake. Excessive consumption contributes to depression.

• Work it out. Physical activity releases feel-good chemicals in your body that help make you happier. Plus, it will rid you of those extra pounds you gained during the holiday season. If the winter weather is keeping you from your regular fitness routine, take it inside. Walk the inside perimeter of a mall or join a gym. Many offer New Year’s specials.

• Share your feelings. Don’t keep your frustrations bottled up. Confide in a trusted friend or family member. Often just talking about what’s bothering you can be a big relief. Your confidant may be able to offer a realistic perspective on what you’re going through.

• Know when to ask for help. If your post-holiday blues don’t go away, or if you experience physical symptoms of depression, talk with your doctor. Treatment is available and may include antidepressants and therapy.

— Source: Baylor Health Care System

According to a new study that appeared in Health Services Research, when they visit the doctor, poor, uninsured people often report racial discrimination when communicating with healthcare professionals. Irena Stepanikova, PhD, an assistant professor of sociology at the University of South Carolina, and a colleague evaluated data on 4,556 U.S. adults who participated in a telephone survey.

Overall, people without insurance had 2.39 times higher odds of perceiving racial and ethnic bias during healthcare visits, compared with people with private insurance. People living below the poverty line were also more likely to report feeling discriminated against. In addition, African Americans and Spanish-speaking Hispanics had almost eight times higher odds of perceiving racial bias compared to whites, whereas English-speaking Hispanics had more than four times higher odds of racial bias. Whites living in poverty had nearly four times higher odds of reporting perceived racial and ethnic bias, compared with other whites.

In a follow-up question, patients noted that what had happened made them feel disrespected and unfairly judged. “Among the most common reasons were, ‘The doctor or staff talked down to me, took other patients before or instead of me, treated other patients better, didn’t listen or pay enough attention to me, ignored me or didn’t explain things well or at all,’” Stepanikova says. Insurance issues also played a role in patient perception of bias, she adds.

— Source: Health Behavior News Service

This year, through a one-year grant awarded Dr. Laura Klinger from the Alabama Council for Developmental Disabilities, The University of Alabama (UA) developed and launched a college transition program, known as UA-ACTS, for students with an autism spectrum disorder (ASD). Three freshmen are currently enrolled in the program, but Klinger envisions the UA program becoming self-sustaining and eventually expanding to serve up to 16 students.

Students in the program, who must first be admitted into UA on their own merits, are assigned graduate level therapists/mentors to assist them in navigating the challenges of college life. During both individual and group sessions, the students are guided in such areas as improving interactions with instructors, building and managing relationships with college peers, including roommates, managing time and improving daily living skills. The students are also monitored for signs of high anxiety and depression, challenges faced by many with an ASD.

The UA-ACTS program coordinates services with UA's Office of Disability Services. UA instructors and residential life staff are educated on some of the challenges faced by people with ASD in the college environment. The magnitude of students entering college world-wide with ASD is a testimony to the success of early intervention programs, Klinger says. In times past, college would not have even been considered an option for many similar students, she says. Others would have found the road rocky.

“For the most part, they don't do very well,” Klinger says of previous generations of students attending college with ASD. Some, of course, overcame the obstacles. Klinger hopes the program can give current students a needed boost.

— Source: Dr. Laura Klinger, University of Alabama

Holiday celebrations focused on food are difficult for persons recovering from eating disorders, and challenging for their family and friends. Many well-meaning persons may find themselves wondering how to behave around persons recovering from eating disorders. Should they encourage their loved one to eat or ignore his or her eating disorder entirely?

“Ideally, family and friends should be sensitive to the fact that their guest or loved one has an eating disorder,” says Theresa Fassihi, PhD, a psychologist with the Eating Disorders Program at The Menninger Clinic. “Respect that, while the meal may be a joyous occasion for you, it may be stressful to a person with an eating disorder, especially one who has recently completed treatment.”

Food-centered events may trigger eating disorder behavior, such and bingeing and purging, for some persons in recovery. To prepare for an upcoming meal, persons recovering from eating disorders often plan in advance what they will eat and may have dietary restrictions that prevent them from eating certain foods.

Fassihi offers some do’s and don’ts for families and friends celebrating the holidays with persons recovering from eating disorders:

Do:

• Offer food to family and friends instead of forcing it on them. Instead of saying, “You have to eat some of my famous pecan pie,” say instead, "Would you like to try a piece of my pecan pie?” Graciously accept “no” as an answer if your family member with an eating disorder turns down a particular dish.

• Treat your loved one with an eating disorder like the rest of the family or friends. Singling out the loved one will make him or her feel uncomfortable and want to avoid being around others.

Don’t:

• Don’t watch your family member with an eating disorder eat or ask questions about what he or she is, or is not, eating.

• Don’t talk about shape or weight—theirs or yours, including complimenting them on their appearance. This could trigger negative feelings or difficult-to-manage thoughts about body image in a person with an eating disorder.

— Source: Menninger Clinic

Although mood disorders and depression may occur at any age during a woman’s life, women seem to more vulnerable during times of hormonal fluctuations, such as the menstrual period, pregnancy, and perimenopause, according to a report released by the Society for Women’s Health Research. For some women, a normal hormonal transition can trigger mild to severe mood disorders including depression and bipolar disorder. “Science has revealed clues as to why these changes may occur in some women,” says Peter Schmidt, MD, an investigator in the National Institute of Mental Health’s Reproductive Endocrine Studies Unit, “but further research is needed to definitively show what causes depression and mood disorders in women during hormonal transitions.”

The Society for Women’s Health Research and the National Institute for Mental Health convened a thought leaders’ roundtable in June to discuss current efforts to understand the effects of hormonal transitions. Roundtable participants observed that postpartum depression affects roughly 10% to 15% of women up to one year after childbirth, but the exact cause is not known. Some scientists believe that chemical changes in the brain may be caused by the shifts in hormone levels during pregnancy and the postpartum period, leaving women vulnerable to depression. Other life cycle changes in a woman’s life such as perimenopause where hormones are shifting may produce similar emotional disturbances.

Scientific research conducted by Schmidt, David Rubinow, MD, at the University of North Carolina at Chapel Hill, and their colleagues illustrated the effect of hormones on human mood by shutting down the ovarian cycle in an attempt to eliminate the symptoms of premenstrual syndrome. After two to three months of ovarian suppression, the study participants’ problematic mood symptoms were greatly reduced. The researchers concluded that when reproductive hormones are removed, premenstrual symptoms or PMS disappears.

— Source: Jennifer Wider, MD, Society for Women's Health Research

Sociological research has shown that when couples move, the husband's career gets a boost, while the wife's career suffers. A University of Iowa professor investigated the reason behind the phenomenon and discovered that couples tend to put more emphasis on the man's career, even if the wife works full-time and is college-educated.

Kimberlee Shauman, associate professor of sociology at the University of California at Davis, and Mary Noonan, associate professor of sociology in the University of Iowa College of Liberal Arts and Sciences, reported the findings on their study on family migration in a recent issue of Social Forces. Using data from the Panel Study of Income Dynamics, an annual survey that tracks families over a 30-year period, they examined the experiences of 5,072 working men and 4,120 working women between ages 25 and 59, all of whom were married. They compared the employment status and salaries of those who moved from one metropolitan area to another (655 men, 371 women) to those who stayed put.

They found that a year after the move, nearly all of the men remained employed, but the women who moved were 22 percentage points less likely to remain employed compared to women who didn't move. The men who moved boosted their salary by an average of $3,000 that year, compared with an average increase of only $700 for men who stayed put. But women who moved reported average salary increases of $750 less than women who stayed put. In future research, Noonan would like to design a qualitative study to find out how couples weigh decisions on whose career matters more.

— Source: University of Iowa Health Sciences

New research at the University of Haifa found that young adults who maintain a close or moderate relationship with their parents exhibit greater independence in their personal lives than those who have a distant relationship. In her research, Irit Yanir, PhD, evaluated how a parent-child relationship is connected to the ability to fulfill society's expectations in terms of settling down and establishing an intimate relationship. Yanir conducted in-depth interviews with psychologists, parents, and young adults between the ages of 23 and 27. An additional 100 families (father, mother, and child) completed 300 surveys as part of the study.

While a close relationship is often viewed as a sign of dependence, the research results show that those with close relationships with their parents were more financially self-sufficient, more independent in their day-to-day lives, professionally stable, felt more mature, and were more likely to be involved in a stable intimate relationship. Those who maintained distant relationship with their parents and tended to make choices out of a need to rebel against their parents' expectations and were less independent into their late 20s. "The research found that following adolescence, the familial connection is an important factor in forming one's identity and living an independent life. It seems that not only can independence and closeness exist together, but they actually flourish together," summarizes Yanir.

— Source: University of Haifa

Males who have a twin sister appear more likely to develop the eating disorder anorexia nervosa than other males, including those with a twin brother, according to a report in a recent issue of Archives of General Psychiatry. Marco Procopio, MD, MRCPsych, of the University of Sussex, England, and Paul Marriott, PhD, of the University of Waterloo, Canada, analyzed data from a study of Swedish twins born between 1935 and 1958. Two sets of diagnostic criteria, one broader and one more narrow, were used to determine which twins had anorexia nervosa.

Overall, female twins were more likely than male twins to develop anorexia nervosa. The one exception was among males who had a dizygotic (fraternal) twin sister. “In fact, their risk is at a level that is not statistically significantly different from that of females from such a pair,” the authors write. Among 4,478 dizygotic opposite-sex twins, 20 females and 16 males had anorexia nervosa using narrow criteria and 32 females and 27 males qualified under the broad criteria. Risk for these female twins was not significantly different from than that of other female twins. “A plausible explanation for this phenomenon is that in pregnancies bearing a female fetus, a substance is produced, probably hormonal, that increases the risk of having anorexia nervosa in adulthood,” the authors write. “Because the male half of an opposite-sex twin pair would also be exposed to this substance, it could account for the observed elevated risk in males with female twins.”

— Source: American Medical Association

With holiday celebrations to attend and family gatherings to prepare for, December can be a busy, joyful time. But for many, heightened expectations and the stresses of holiday events can increase anxiety and cause depression. Since holiday schedules are hectic and often include unstructured time, planning ahead for how to handle difficult situations can help people cope with holiday-related stress and anxiety.

“If you plan ahead and focus on what you really enjoy about the season, you can spend more time ‘living in the moment,’ which is the key to getting the most out of each holiday experience,” says Mark H. Rapaport, MD, chair of the department of psychiatry and behavioral neurosciences at Cedars-Sinai Medical Center. Rapaport offers several suggestions for coping and enjoying the holiday season more fully:

• Have realistic expectations of interactions you’ll be having with family and friends. Chances are that people will have not changed much from last year.

• Make a list and prioritize the activities that are important to you. Make time for those; and consider carefully whether you absolutely must do everything on that list.

• Don’t lose sight of the meaningful moments of the season. Look for them, and be optimistic that you’ll find them.

• Limit your drinking. Drinking too much can lead to bad behavior, hangovers, and remorse, all of which can lead to depression.

• Let others share responsibilities of the season. No one person should feel burdened by all of the shopping, party planning, cooking, and holiday activities.

• Make an active effort not to worry so much about the details. Live in the moment as much as possible.

• Be sure to get regular exercise. Walking for 30 minutes three times a week can make a difference in how you feel.

• Keep track of your holiday spending. Gifts that you can’t afford won’t make you happy—and the cost of the gift probably won’t matter to the receiver. Consider the more important aspect of giving—making the recipient feel good in knowing that you cared.

• Try to eat well and get enough rest. Hard to do, but the benefits of both are obvious.

• Spend time with supportive and caring people; reach out to others who may benefit from your support.

• Make time for yourself. Everyone needs downtime.

• Remember that there is no ideal or model for a perfect holiday. With second marriages and so many different types of families, feel free to create your own unique way to celebrate.

— Source: Cedars-Sinai Medical Center

A program that started as an attempt to find a solution to homelessness in San Francisco is now being copied in more than 130 cities and counties in 26 states around the United States. Project Homeless Connect is serving as a role model for similar programs in Oregon, Nevada, Texas, Missouri, New York, and Florida. It’s also being used internationally in Canada, Puerto Rico, and Australia.

The reason why is simple: The program works. To honor that success the Federal Government has declared December 3 to 7 National Project Homeless Connect Week. "Instead of averting our eyes from homeless people and ignoring them, Project Homeless Connect offers us the opportunity to look our homeless neighbors in the eye and engage them," indicates Philip Mangano, executive director of the federal United States Interagency Council on Homelessness. The core of why the program works in San Francisco and around the country.

— Source: California Pacific Medical Center

Researchers at Wake Forest University Baptist Medical Center are the first in the United States to develop an HIV prevention and intervention program for adolescent runaways that focuses on their strengths. The Runaway Youth Project is based on a Strengths-Based Case Management (SBCM) model. For example, if a teen doesn’t excel in a certain subject in school, but is strong in another, the case manager would help the participant to identify the skills he has developed in his stronger area, and show him how he can apply those same skills to his more challenging areas. Liz Arnold, PhD, assistant professor of psychiatry and behavioral medicine, and her colleagues used the SBCM model and specifically focused on the youth as the primary target of intervention, as opposed to the family.

Other components of this model include collaborating with law enforcement to recruit participants so that they can target the teens before they become homeless. “Once the teen is homeless, their chances of HIV risk greatly increase,” said Arnold. “Because this model focuses on early intervention—when they’ve only run away one to three times—it was really important to work with the officers who would talk to the kids and their families and refer them to us early into the trajectory of runaway behavior.” Arnold and her colleagues recruited participants aged 12 to 15 who had run away but returned home. It involved 12 months of intervention with three months of follow-up. “The kids were very receptive to having an adult role model. That connection with their case manager was a pivotal piece,” says Arnold.

— Source: Wake Forest University Baptist Medical Center

New research reveals that mental illness and drug addiction often go together because they may stem from a common cause: developmental changes in the amygdala, a part of the brain linked to fear, anxiety, and other emotions. A full report on why these comorbid disorders may develop recently appeared in Behavioral Neuroscience. Lead author Andrew Chambers, MD, cites clinical reports that at least half the people who seek help with addiction or mental-health treatment have co-occurring disorders. To find the scientific basis for this complex pairing, which has in the past been attributed to self-medication, Chambers’ team at the Indiana University medical school compared the adult mood- and drug-related behavior of two groups of adult rats: those whose amygdalas were surgically damaged in infancy and those whose amygdalas were left intact but who underwent a sham surgery, to equalize their treatment.

Rats with damaged amygdalas grew up abnormally under-responsive to ambiguous or potentially threatening stimuli. Crucially, these same rats also were significantly more sensitive to cocaine after just one exposure. And rats given repeated cocaine injections later showed even stronger expressions of the enduring changes in behavior—suggesting an overall hypersensitivity to the addictive process.

To improve the effectiveness of treatments for dual diagnosis, Chambers would like to see educators, counselors, physicians, and scientific researchers integrate insights into both mental health and addiction. Funding the simultaneous treatment of both disorders would also help, he observes, given that “dual-diagnosis cases are the mainstream among these patients, probably because addiction and mental illness are strongly linked by neurobiology.”

— Source: American Psychological Association

Depressed, older adults with diabetes live longer when they are treated for depression, according to a study in a recent issue of Diabetes Care. The depression study, which followed primary care patients in the New York City, Philadelphia, and Pittsburgh areas for five years, also showed that treating depression reduced mortality more for those who had diabetes than for those who did not. “Depression is not only common in persons with diabetes but contributes to not taking medicines, not following prescribed diets, and overall reduced quality of life,” says lead researcher Hillary R. Bogner, MD, MSCE, assistant professor at the department of family practice and community medicine at the University of Pennsylvania.

Previous studies have drawn a link between diabetes and depression, and between the combination of the two an increased risk of premature death. This is the first known study to examine the relationship between diabetes and mortality in a depression intervention trial. The results led researchers to conclude that better models of care should be developed that integrate depression management into the treatment of people with diabetes. Depressed people with diabetes who received more resources for depression treatment were one half as likely to die over a 5-year period compared with depressed people with diabetes who did not receive more resources for depression treatment.

— Source: American Diabetes Association

In theory, psychiatric advance directives provide a way to improve medical decision making during a mental health crisis. Directives indicate, in advance, what treatments a patient prefers or who should make decisions if he or she becomes incapacitated. However, two key controversies surround these directives, reports the Harvard Mental Health Letter. Psychiatric advance directives differ from general advance care directives in two ways. First, general directives dictate decisions about end-of-life treatments that the patient has never actually experienced. In contrast, psychiatric patients are generally dealing with chronic illnesses and have experience with the treatments. Second, the goal of a general advance care directive is to help life end in comfort; the goal of a psychiatric advance directive is to maximize the chances of recovery, while minimizing unwanted interventions.

Controversy may arise when clinicians are given license to override a psychiatric advance directive. Most state laws give clinicians discretion to override a directive when a patient is involuntarily committed to a facility, when a patient’s wishes are not feasible, or when the directive conflicts with the current standard of care. However, clinicians are expected to honor other preferences expressed in the documents. Another point of controversy relates to when patients may revoke directives. A competent individual can revoke a psychiatric advance directive at any time. But problems can occur when a patient tries to revoke the document during a psychiatric crisis. Some patients insert a clause that explicitly states that the document should not be revoked during a period of incapacity.

— Source: Harvard Mental Health Letter

New research shows that how people view their abilities in the workplace impacts how they respond to success. Jason Plaks, PhD, a social psychologist at the University of Toronto and Kristin Stecher, a research scientist at the University of Washington, found that those who thought of their capabilities as fixed were more likely to become anxious and disoriented when faced with dramatic success, causing their subsequent performance to plummet, compared with those who thought of their abilities as changeable.

In one representative study, Plaks and Stecher used a questionnaire to classify participants into those who endorsed a fixed view of intelligence and those who endorsed a malleable view. Then participants took three versions of what was purported to be an intelligence test. After the first test, all participants were given a lesson on how to improve their score. After the second test, participants were randomly assigned to be told that their performance had improved, stayed constant, or declined. Among those who believed they had improved, those with the fixed view became more anxious and performed worse on the third test than those with the malleable view. However, among participants who believed that their performance had failed to improve, it was the malleable view participants who grew anxious and underperformed compared with their fixed view counterparts.

— Source: University of Toronto

Only 10% of women think it is safe for women to take medication for depression while they are pregnant, compared with 68% of doctors, according to a new survey of women and physicians released today by the Society for Women’s Health Research. Even after pregnancy, in the postpartum period, only one half of women think it is safe for women to take medication for depression, compared with 97% of doctors.

“This survey shows a tremendous disconnect between doctors’ beliefs about managing depression and the perceptions held by women,” says Sherry Marts, PhD, vice president of scientific affairs for the Society, a Washington, D.C., based advocacy organization. “The healthcare community needs to do a better job communicating with women about depression. We need to carefully explain the full range of treatment options for mood disorders and the pros and cons of taking medications during pregnancy and after pregnancy so that women can make better informed choices.” African American women and women aged 18-34 in the survey were even more likely than others to say that it is not safe to take depression medications during pregnancy or the postpartum period.

“Many pregnant and postpartum women falsely think that depressive symptoms, and even clinical depression, are part of the normal experiences of being pregnant and delivering a baby,” says Kimberly Yonkers, MD, an associate professor of psychiatry and obstetrics and gynecology at the Yale University School of Medicine in New Haven, Conn. “Moreover, they often assume that these symptoms will spontaneously go away when that is not always the case. There are a range of treatments available to women and we need to get the message out and encourage depressed women to access care for their emotional symptoms.”

— Source: Society for Women's Health Research

A new survey indicates that among large employers, many have not examined data on physician quality or shared health plan or physician data with employees that could help improve the value and quality of health benefits, according to a study in a recent issue of The Journal of the American Medical Association.

“Value-based purchasing has often been portrayed as the lynchpin to quality improvement in a market-based healthcare system. Under this paradigm as it was originally conceived, employers and other large purchasers of healthcare are expected to contract with health plans according to quality and cost. Other key elements of value-based purchasing include the promotion of quality improvement in negotiations with health plans and facilitating informed choice of health plan through dissemination of comparative cost and quality information to employees,” the authors write. Although a small group of the largest national employers have been active in improving healthcare quality through the promotion of quality measurement, reporting, and pay for performance, it is unknown whether these ideas have significantly effected employer-sponsored health benefit purchasing.

Meredith B. Rosenthal, PhD, of the Harvard School of Public Health, Boston, and colleagues conducted a national survey of large employers regarding value-based purchasing of healthcare and related efforts to improve the quality of healthcare and employee health. The researchers interviewed by telephone executives at 609 of the largest employers across 41 U.S. markets between July 2005 and March 2006. The 41 randomly selected markets have at least 100,000 persons enrolled in health maintenance organizations, include approximately 91% of individuals enrolled in health maintenance organizations nationally, and represent roughly 78% of the U.S. metropolitan population. The 26 largest employers were identified in each market, with firms ranging in size from 60 to 250,000 employees.

“During the last decade, a number of high-profile employers have become involved in delivery system reform and quality improvement in national and local spheres. Nonetheless, our findings suggest that employers as a whole do not appear to be directly implementing contracting strategies and programs to improve the quality and value of health benefits, except as they relate to supporting improved employee health behavior. Efforts to alter the dynamics of health plan and provider competition will likely have to come from other sources, including private employer coalitions, multistakeholder collaborative organizations, and the public sector,” the authors write.

— Source: American Medical Association

Women scientists are not pursuing advanced research careers because of a heavier burden of family responsibility and lower confidence compared with men, according to a study by the National Institutes of Health (NIH) of its own research staff appearing in a recent issue of the EMBO Reports.

Although women comprise nearly half of all undergraduate, graduate, and postdoctoral scientists nationwide, after committing 10 to 15 years to scientific training, many leave academic research during the career transition to faculty or tenured positions. For example, at the NIH, only 29% of the tenure-track principal investigators (PI) and 19% of tenured Pis—the NIH equivalent of assistant and full professors, respectively—are women. These figures have hardly changed over the last decade and mirror the disparities at most academic research institutions. "The NIH is not alone in this problem," says NIH Director Elias A. Zerhouni, MD. "There's a great brain drain occurring at research institutions across the country as women fall off the tenure track. The reasons, we found, are deep-seated and numerous. This study is a step forward in remedying the problem."

Over 1,300 male and female NIH postdoctoral researchers, of the 2,400 total postdocs at the NIH, responded to a survey. The task force found that although men and women rated themselves equally when it came to professional skill, men were significantly more confident that they could obtain a PI position and become tenured. The reported contributing factors to this disparity fall into two categories: family responsibilities and self-confidence. The vast majority of married women have a full-time working spouse, whereas about half of married men have a spouse that works part-time or within the home. Moreover, among dual-career couples, women are more likely to make career concessions than men. Spending time with family, plans to have children, affordable child care, travel, and proximity to spouse's work place were some of the considerations that were weighed more heavily by women, whereas salary was more important to men.

"Family considerations are a major, but not the only, deterrent to pursing an academic career," says Orna Cohen-Fix, PhD, a corresponding author of the report and senior investigator at the National Institute of Diabetes and Digestive and Kidney Diseases. "An increase in the number of women postdocs who decide to pursue an advanced research position will translate, in time, to a greater representation of women in tenured faculty positions. Our findings suggest that the loss of talented women from the research track can be reduced by mentoring and a change in the scientific culture to accommodate the needs of both women and men who wish to combine family and scientific careers."

— Source: The National Institutes of Health

Older adults often carry a deeply ingrained belief that inactive, sedentary lives are an inevitable part of aging. But this mindset is not just wrong, it can be changed—with positive physical and mental health results. In a new UCLA study, researchers show that older adults who participated in a pilot test for a program aimed at changing this mindset became more physically active, increasing their walking levels by about 24%—an average increase of 2.5 miles per week. The study in the online version of the Journal of the American Geriatrics Society.

"We can teach older adults to get rid of those old beliefs that becoming sedentary is just a normal part of growing older," says Catherine Sarkisian, MD, MSPH, assistant professor of geriatrics at the David Geffen School of Medicine at UCLA and the study's lead author. "We can teach them that they can and should remain physically active at all ages."

The researchers used a technique known as "attribution retraining" to effect a change among study participants about what it means to age and what to expect out of it. The researchers worked with 46 sedentary adults age 65 and older from three senior centers in the Los Angeles area. The participants attended four weekly, hour-long group sessions led by a trained health educator who applied an attribution retraining curriculum. The participants were taught to reject the notion that becoming older means becoming sedentary and to accept that they can continue engaging in physical activity well into old age. Each attribution retraining session was followed by a one-hour exercise class that included strength, endurance and flexibility training.

As a result of the program, participants increased the number of steps they took per week from a mean of 24,749 to 30,707—a 24% increase—and their scores on the age-expectation survey rose by 30%. Also, their mental health-related quality of life improved, and they reported fewer difficulties with daily activities, experienced less pain, had higher energy levels, and slept better. "An intervention combining attribution retraining with a weekly exercise class raised walking levels and improved quality of life in sedentary older adults in this small pre-post community-based pilot study," the researchers write. "Attribution retraining deserves further investigation as a potential means of increasing physical activity in sedentary older adults."

— Source: University of California, Los Angeles, Health Sciences

Screening tests widely used to identify children with reading problems are being misapplied, landing students in the wrong instructional level and delaying treatment for their true difficulties, says new research from National-Louis University and the University of Maryland. The researchers found that oral reading tests fail to distinguish between children who can’t understand words on a page and those who have language problems that make it difficult to prove their reading competence verbally. Children with these so-called “word-finding” difficulties can’t manage to say out loud what they read on the page. The study, published in a recent issue of Reading Psychology, recommends silent reading tests and limited use of oral ones.

The researchers used an experimental design, testing one group of 15 “typical learning” first-graders and another group of 25 second- and third-graders. The older children had word-finding difficulties and were getting remedial reading instruction. All the subjects were given an experimental reading assessment previously developed and tested by the researchers, as well as other language-related tasks. “We tested the first-graders with the idea that they were rookies at reading,” says psychologist Rochelle Newman, coauthor of the study and a University of Maryland professor of hearing and speech sciences. “If the second- and third-graders, the ones with the word-finding problems, hadn’t learned to read, as their schools believed, then they would perform on the silent tests only about as well as the rookies. But they didn’t. The older children surpassed the rookies on these silent tests. They had learned, but just couldn’t show it.”

The older children scored 98% in the silent test compared to 58% for the first-graders. The results also verified that children with word-finding difficulties had a much harder time with oral tests than silent ones. Accuracy on oral reading tests for these older children ranged from 57% to 62%. But on silent tests using the same words, their reading accuracy was significantly better, ranging from 85% to 88%. The study recommends the use of silent tasks to determine the actual reading ability of children with speech or language difficulties. For example, to check reading decoding skills, children can be asked to “point to the word” or “find the word.” Multiple-choice questions can be used to check silent reading comprehension.

— Source: University of Maryland, College Park

New research into lifelong alcohol consumption reveals that heavy binge drinking by adolescents and young adults is associated with increased long-term risk for heart disease, high blood pressure, type 2 diabetes, and other metabolic disorders. The risk is lower in people who start drinking alcohol later in life and maintain more moderate drinking patterns. The study, accepted for publication in the Journal of Clinical Endocrinology & Metabolism, also indicates that the increased health risks were independent of the total amount of alcohol consumed over a lifetime, or whether or not people stopped or curtailed drinking as they matured.

"To fully understand the effect of alcohol consumption on health, you need to consider lifetime drinking patterns," says Marcia Russell, PhD, of the Pacific Institute for Research and Evaluation's Prevention Research Center in Berkeley, Calif., and senior author of the study. "Early initiation of alcohol drinking and heavy drinking in adolescence and early adulthood seem to be associated with a number of adverse health effects collectively known as the metabolic syndrome.” The term metabolic syndrome describes a cluster of metabolic risk factors that increase the chances of developing heart disease, stroke, and type 2 diabetes. The exact cause of the metabolic syndrome is not known, but genetic factors, too much body fat (especially in the waist area), and lack of exercise increase the risk of developing the condition.

Russell and her colleagues based their research on data from the Western New York Health Study (WNYHS), conducted between 1996 and 2001. This study retrospectively collected lifestyle information on more than 2,800 people who reported that they were regular drinkers at one point in their lives. The study also collected data on the prevalence of the metabolic syndrome and its individual components, including obesity, high triglycerides, low HDL cholesterol, elevated blood pressure, and high fasting glucose. The researchers speculate that the reason for the increased risk for metabolic syndrome found in the study may be associated with the adverse health effects of early unhealthy drinking patterns, which were carried over to later life. Also, early peak drinkers may have adopted other lifestyle habits detrimental to cardio-metabolic health.

— Source: Endocrine Society

Children entering kindergarten with elementary math and reading skills are the most likely to do well in school later, even if they have various social and emotional problems, say researchers who examined data from six studies of close to 36,000 preschoolers. Children’s attention-related skills also mattered, the researchers found. These findings are reported on in a recent issue of Developmental Psychology.

From a meta-analysis of the six large-scale longitudinal studies’ results, economist Greg J. Duncan, PhD, of Northwestern University, and 11 coauthors found that mastering early math concepts, such as knowledge of numbers and understanding the order of numbers, best predicted later success. Mastering early language and reading skills that included vocabulary, knowing letters, and understanding phonetics were next in predicting later achievement. Also contributing to later achievement were children’s attention-related skills, including the ability to control hyperactive behavior, to concentrate while completing a task, and to be motivated for learning. Surprisingly, difficulty getting along with classmates, aggressive or disruptive behaviors, and sad or withdrawn behaviors did not detract from later learning.

School readiness skills and behaviors were measured at school entry (around age 5) and later achievement was measured between the ages of 7 and 14. Even after controlling for children’s prior cognitive ability, the authors found that early math skills were strong predictors of later math achievement and predicted later reading achievement as well as early reading skills. These and other patterns were similar for boys and girls and for children from both upper- middle-class and poor families.

— Source: American Psychological Association

A new study by University of Virginia (U.Va.) clinical psychologists has found that teens who have sex at an early age may be less inclined to exhibit delinquent behavior in early adulthood than their peers who waited until they were older to have sex. The study also suggests that early sex may play a role in helping these teens develop better social relationships in early adulthood. The finding is published in the online edition of the Journal of Youth and Adolescence, and runs counter to most assumptions that relate early teen sex to later drug use, criminality, antisocial behavior and emotional problems. The finding also contradicts parts of a study published earlier this year in the same journal that found a connection between early teen sex and later behavioral problems.

The researchers analyzed data on 534 same-sex twin pairs in the United States gathered at three time points over a seven-year period. By examining surveys of twins, the investigators were able to eliminate the genetic and socio-economic variables that otherwise might influence the behaviors of adolescents. “We got a very surprising finding, particularly that early sex seems to forecast less antisocial behavior a few years later, rather than more,” says Kathryn Paige Harden, the study’s lead author and a PhD candidate in clinical psychology at the U.Va.

Harden does acknowledge that early adolescent sexuality is linked to early pregnancy and disease, but these risks are not inevitable. She notes that in other Western countries, such as Australia, there are similar rates and patterns of teen sexual activity as in the United States, but drastically lower rates of teen pregnancy. She attributes this to a poor level of sexual health knowledge in the United States, ineffective contraceptive use and lower abortion rates.

— Source: University of Virginia

"Maltreatment in childhood is a global issue," says Melissa Jonson-Reid, PhD, a child welfare expert and a professor of social work at Washington University in St. Louis. According to the Department of Health and Human Services, in the United States there are about 3 million reports of abuse or neglect each year, and about 60% of such reports are deemed to meet states' criteria for investigation or assessment.
Jonson-Reid offers six ways to get involved in protecting children from mistreatment:

1. Become a Court Appointed Special Advocate (CASA) for children in foster care. More information is available at http://www.nationalcasa.org/about_us/index.html

2. Check with your local Department of Transportation to see if they offer Children's Trust Fund license plates or something similar.

3. Join an organization that helps lobby for and support child protection and child welfare efforts like the American Humane Association, the American Professional Society on the Abuse of Children, or the International Society for the Prevention of Child Abuse and Neglect. A detailed list of organizations across the world that work on issues related to child abuse and neglect can be found at: http://www.nspcc.org.uk/Inform/resourcesforprofessionals/Directories/international_wda48965.html

4. Volunteer with a local crisis nursery program. Crisis nurseries offer residential care with the hopes that they can prevent abuse or neglect by caring for the children briefly while a parent addresses the current crisis.

5. Stay alert about local/state opportunities to support legislation and initiatives that support maltreatment prevention and intervention through groups like Citizens for Missouri's Children.

6. Consider a career in policy, programs, or intervention that prevent child maltreatment and/or assist children who have experienced maltreatment.

— Source: Washington University in St. Louis

Among adolescents who have attempted suicide, white youths are most likely to have reported receiving mental health services, according to a new study presented at the American Public Health Association’s Annual Meeting & Exposition in Washington, D.C. Using data from a national survey of a representative sample of adolescent suicide attempters aged 12 to 17, researchers found that less than one half of the youths received any treatment for their suicidal behaviors in the year preceding the interview.

Low for all groups, rates of mental health service use also varied by race/ethnicity. While 50% of white youths reported receiving services, rates were substantially lower for African Americans (31.3%), Hispanics (36.5%) and other ethnic groups (38.5%). This disparity was particularly evident when looking at use of outpatient mental health services among those with suicidal behaviors, with the behavior highest among whites (29.2%) and lowest among African Americans (12.6%); however this gap was not as wide when comparing the use of school-based services.

— Source: American Public Health Association

According to a study in a recent issue of Medical Care, Limited English Proficiency (LEP) is a key barrier to the growing discrepancy in mental health services delivered to the Latino community. Carlos Blanco, MD, PhD, of Columbia University and colleagues used nationally representative survey data to compare trends in mental healthcare for U.S. Hispanics vs. non-Hispanics. On most measures of mental health care, Hispanics showed no change from 1993-96 to 2000-02.

In contrast, mental health services provided to non-Hispanic patients increased substantially during the same period. For example, the percentage of doctor's office visits resulting in diagnosis of a mental disorder remained at about 5% for Hispanic patients. For non-Hispanic patients, the same measure increased from 6% to 9%. There was a sharp difference in prescriptions for drugs used to treat mental disorders (psychotropic medications). The rate of such prescriptions decreased slightly for Hispanic patients (from about 10% to 9%), compared with a significant increase for non-Hispanics (from 10% to 12.5%). Psychotherapy and psychiatrist visits also decreased for Hispanic patients, but increased for non-Hispanics. The "growing ethnic disparity" in mental health care "may be related to a mismatch between the large growth of the Hispanic population and the healthcare system's ability to adapt to this growth," Blanco and colleagues write.

— Source: Lippincott Williams & Wilkins

Physical dating violence (PDV) affects almost one in every 11 adolescents, according to research presented at the American Public Health Association’s 135th annual meeting in Washington, D.C. The study, which looked at data from the 2005 National Youth Risk Behavior Study, also found that contrary to common general perception, males and females equally report being victims of PDV. The researchers found that in their study population of 6,951 male and 6,807 female students in grades 9 through 12, 9% of boys and 9.2% of girls responded yes to the question “during the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?”

Also significant among the findings was that certain behaviors are associated with being a victim of PDV. For both male and female adolescents, current sexual activity, alcohol use, physical fighting, sexual victimization, and suicidal thoughts were significant predictors of PDV. Poor body image was a significant predictor of PDV in females but not in males, whereas illicit drug use was a significant predictor in males but not in females. “It is imperative that counselors and care providers are aware of the gender differences in the predictors of physical dating violence in adolescents,” said Saba Masho, MD, MPH, DrPH, lead researcher on the study. “Knowing these differences will alert them to pay particular attention to female adolescents with poor body image and male adolescents using illicit drugs.”

— Source: American Public Health Association

According to the most comprehensive survey of people affected by Hurricane Katrina, results of which were presented to the U.S. Senate Committee on Homeland Security and Government Affairs Ad Hoc Subcommittee on Disaster Recovery, the percentage of prehurricane residents of the affected areas in Alabama, Louisiana, and Mississippi who have mental disorders has increased significantly compared with the situation five to eight months after the hurricane. These findings counter a more typical pattern from previous disasters where prevalence of mental disorders decreases as time passes. The detailed results of this report are in Molecular Psychiatry.

The fact that hurricane-related stressors were still quite common in the population nearly two years after the hurricane, and that much of this could be attributed to these continuing stresses suggests that efforts to address the problem of increased mental illness and suicidality among Hurricane Katrina victims must confront continuing needs for practical and logistical assistance. This may be particularly challenging since many prehurricane residents of the affected areas are now living elsewhere in the country. Still, it is especially important to reach these geographically displaced people because of their comparatively high risk of serious mental illness.

— Source: Harvard Medical School

A questionnaire study of more than 500 gay, lesbian, and bisexual employees across the United States has found that “fears about disclosing a gay identity at work had an overwhelmingly negative relationship with their career and workplace experiences and with their psychological well-being.” The researchers, Belle Rose Ragins and Romila Singh of the University of Wisconsin—Milwaukee and John M. Cornwell of Rice University, wrote in The Journal of Applied Psychology that “these findings were both striking and disturbing; those who reported more fear of the negative consequences of full disclosure had less positive job and career attitudes, received fewer promotions, and reported more physical stress-related symptoms than those who reported less fear.”

For those working in what they perceived as a nonsupportive environment, the costs of nondisclosure were significant. “Those who feared more negative consequences to disclosure reported less job satisfaction, organizational commitment, satisfaction with opportunities for promotion, career commitment, and organization-based self-esteem, and greater turnover intentions than those who feared less negative consequences,” wrote the researchers. “Those who feared more negative consequences reported more (job) role ambiguity, more (job) role conflict, and less workplace participation than those who feared less negative consequences,” the report continued. “LGB employees who feared more negative consequences also reported greater psychological strain than those who feared less negative consequences.” Psychological strain was described as stress-related symptoms experienced on the job, work-related depression, and work-related irritation.

— Source: Alliant International University

Not so long ago, being a good parent meant mindlessly enjoying the Santa myth with your child. In the 21st century, however, being a parent at Christmas may mean a sack full of worries. One of which is if parents are foisting a grand deception on children who inevitably will be disappointed and disillusioned. According to child psychologist Bruce Henderson, professor in the psychology department at Western Carolina University, children’s thinking about Santa Claus and other figures reflects their general level of cognitive development. “Santa is just one of the many fantasy figures that exist in the preschooler’s world,” says Henderson. “Adults might just be wasting time by trying to get a child of that age to give up on such a warm and fuzzy character to accept adult realities.”

The trouble comes when a child begins to think in a more concrete, rule-governed way and has doubts about Santa’s ability to get everywhere on Christmas Eve, or when disbelieving peers start raising questions. “[Parents] are torn, however, about what to do when their children directly confront them with their doubts,” he says.

So, what should the parent do?

As in many aspects of parent-child relations, perhaps the best advice for parents is to let the child provide the cues, Henderson says. “Forcing an elaborate Santa Claus story on children serves no good purpose for child or parent,” he said. “On the other hand, following the child’s lead in fantasy play about Santa Claus is likely to do no more harm than imaginative play surrounding Elmo or Mickey Mouse. Parents can respond to direct questions honestly with answers appropriate to their children’s developmental levels.”

— Source: Western Carolina University

When a teenager is killed in a car accident, or succumbs to disease, the tragedy often requires school counselors to help the victim’s friends cope with the loss and come to terms with losing someone close to them. But, as weeks and months go by, where can they turn? It turns out social media sites like MySpace are used increasingly as safe havens for grieving teenagers and are truly helpful during times of the year, like the holiday season, when grieving process is especially difficult.

Diana Nash, a professor of psychology at Marymount Manhattan College and a counselor specializing in grief and bereavement, has begun research into the phenomenon of teens using MySpace, Facebook, and other social media sites as a means of helping them through their loss.

“Turning to MySpace or Facebook is the most natural thing in the world to teens. It’s the world they live in and a good place for them to express emotions, especially the powerful emotions of death and grieving. During a tragedy, teenagers have even more trouble talking to their parents or other adults than usual. Online is where they seek out others in grief and console each other.”

— Source: Diana Nash, professor of psychology, Marymount Manhattan College, New York; private practice specializing in grief and bereavement. (Halstead Communications)

Two new clinical reports from the American Academy of Pediatrics (AAP) will help pediatricians recognize autism spectrum disorders (ASDs) earlier and guide families to effective interventions, which will ultimately improve the lives of children with ASDs and their families.

The first clinical report, “Identification and Evaluation of Children With Autism Spectrum Disorders,” provides detailed information on signs and symptoms so pediatricians can recognize and assess ASDs in their patients. Language delays usually prompt parents to raise concerns to their child’s pediatrician—usually around 18 months of age. However, there are earlier subtle signs that if detected could lead to earlier diagnosis. The report advises pediatricians to be cognizant of signs of ASD, as well as other developmental concerns, at every well-child visit by simply asking the parents if they or their child’s other caregivers have any concerns about their child’s development or behavior. If concerns are present that may relate to ASD, the clinician is advised to use a standardized screening tool.

Educational strategies and associated therapies, which are the cornerstones of treatment for ASDs, are reviewed in the second AAP clinical report, “Management of Children With Autism Spectrum Disorders.” The report strongly advises intervention as soon as an ASD diagnosis is seriously considered rather than deferring until a definitive diagnosis is made. Pediatricians who treat children with ASDs should recognize that many of their patients will use nonstandard therapies and it’s important for pediatricians to become knowledgeable about complementary and alternative medicine (CAM), ask families about current and past CAM use, and provide balanced information and advice about treatment options, including identifying risks or potential harmful effects. They should avoid becoming defensive or dismissing CAM in ways that convey a lack of sensitivity or concern, but they should also help families to understand how to evaluate scientific evidence and recognize unsubstantiated treatments.

— Source: American Academy of Pediatrics

Many scholars have argued that ethical behavior is the result of simple judgments between right and wrong. Others suggest that the driving force behind ethical behavior is the individual’s moral identity, or whether the individual thinks of him/herself as an ethical person. New research from the University of Washington suggests that both of these forces are at play. In two separate studies, Scott Reynolds, an assistant professor in the Michael G. Foster School of Business, and Tara Ceranic, a doctoral student studying business, surveyed roughly 500 college students and managers about their ethical behaviors.

In the first study, researchers asked students if they would have cheated in college in order to score better on a test. Those who explicitly considered themselves to be moral people and considered cheating to be morally wrong were the least likely to cheat. In contrast, students who considered themselves to be moral but saw cheating as an ethically justifiable behavior were the worst cheaters.

In a second study, Reynolds and Ceranic presented company mangers with a scenario that was morally ambiguous: A hard-working hourly employee completed her work and was prepared to go home early, but she needed the hours. Each manager was presented with different options for dealing with the situation. These varied from being very accommodating (giving the employee the rest of the day off with pay) to very strict (keeping her at work and finding additional work for her to complete), with more moderate options in between. As expected, those who viewed themselves as moral people were most likely to take the most extreme alternatives, and chose either to be extremely accommodating to the employee or exceedingly strict about the rules in the workplace. This study proved that their moral identity motivated them to the most extreme behaviors.

— Source: University of Washington

The largest and most up-to-date study of suicides among depressed veterans was recently published online. The study found that the predictors of suicide among veterans in depression treatment differ from those seen in the general American population, with younger, white, non-Hispanic men having the highest risk among the veterans. Veterans with substance abuse issues and those who had been hospitalized for psychiatric reasons in the year before their depression diagnosis also had a higher suicide risk. Surprisingly, older veterans who had been diagnosed with posttraumatic stress disorder (PTSD) in addition to depression had a lower overall rate of suicide than those without a PTSD diagnosis, perhaps because they were more likely to receive care through Veterans Affairs (VA) PTSD programs.

The researchers analyzed comprehensive data from 807,694 veterans of all ages diagnosed with depression and treated at any Veterans Affairs facility nationwide between 1999 and 2004. In all, the researchers found that 1,683 of the depressed veterans committed suicide during the study period, representing 0.21 percent of the depressed veterans studied. They then analyzed the characteristics of all the depressed veterans who committed suicide, and calculated suicide hazard ratios and suicide rates per 100,000 person-years for each subgroup. Difference in rates among depressed veterans of different age groups were striking, with 18-44-year-olds committing suicide at a rate of 94.98 suicides per 100,000 person years, compared with 77.93 for the middle age group and 90 for the oldest age group.

— Source: University of Michigan Health System

Large numbers of American adolescents are putting themselves and others at great risk by driving while under the influence of illicit drugs or alcohol, according to a study funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH). In 2006, 30% of high school seniors reported driving after drinking heavily or using drugs, or riding in a car whose driver had been drinking heavily or using drugs, at least once in the prior two weeks. These findings are based on data from the Monitoring the Future study, in which nationally representative samples of high school seniors have been surveyed annually since 1975. The data analysis is published in the Journal of Studies on Alcohol and Drugs.

“These findings are another wake-up call that we cannot afford to be complacent about this great public health risk,” says Elias A. Zerhouni, NIH director. “This study shows that not only are too many teens putting themselves and others at risk by driving under the influence of drugs, but that there has been little improvement in the past six years.” Although there was some progress between 2001 and 2003, with rates declining from 35 to 31%, between 2004 to 2006 rates leveled off at just under 30%. Patrick O’Malley, PhD, the lead author of the study observes that, “Driving under the influence is not an alcohol-only problem. In 2006, 13% of seniors said they drove after using marijuana while 10% said they drove after having five or more drinks.”

“Most teens are aware of the dangers of drinking and driving, yet many ignore it. And many don’t seem to recognize the dangers of driving after using illicit drugs, including marijuana.” says Nora Volkow, MD, NIDA director. “Educational efforts need to be targeted to include the dangers of both drinking and drugged driving.” To inform prevention efforts, the researchers also sought to examine what demographic and lifestyle characteristics were associated with these behaviors. For example, males were more likely than females to drive after heavy drinking or marijuana use. And although there was little correlation between impaired driving and socioeconomic status or geographic region, individual lifestyle factors such as high religiosity, good grades, low truancy, or having two parents living at home were all associated with a lower likelihood of engaging in risky driving behaviors.

— Source: The National Institutes of Health

A new analysis suggests that about 3.4 million Americans aged 71 and older—one in seven people in that age group—have dementia, and 2.4 million of them have Alzheimer's disease (AD). The study, supported by the National Institutes of Health (NIH), is the latest in a series of analyses attempting to assess the prevalence of dementia and AD, the most common form of dementia. Published recently in Neuroepidemiology, the study is the first to estimate rates of dementia and AD using a nationally representative sample of older adults across the United States.

Brenda L. Plassman, PhD, of Duke University Medical Center, with Kenneth M. Langa, MD, PhD, and others, conducted the analysis as part of the Aging, Demographics, and Memory Study (ADAMS). ADAMS is a sub-study of the larger Health and Retirement Study (HRS), the leading resource for data on the combined health and economic circumstances of Americans over age 50.

A team of clinicians reviewed the evaluation information collected from 856 HRS participants aged 71 and older and made a preliminary assessment of each person's cognitive status. A consensus panel of other medical experts then used well-accepted diagnostic criteria to determine if the participant had normal cognitive function, cognitive impairment without dementia, or dementia. Such criteria further were used to discern the type of dementia, including AD or vascular dementia, the second most common cause of dementia in older adults.

Based on the experts' classifications, Plassman, Langa and coauthors estimated the national prevalence and total numbers of people age 71 and older, by age group, with any dementia and with AD or vascular dementia in 2002. According to their calculations, 13.9% of Americans aged 71 and older have some type of dementia, 9.7% of Americans in that age group have AD, and 2.4% have vascular dementia. AD accounted for about 70% of all dementia cases among people 71 and older.

As in other studies, the ADAMS analysis showed that the prevalence of dementia increases significantly with age. Five percent of people aged 71 to 79, 24.2% of people aged 80 to 89, and 37.4% of those aged 90 or older were estimated to have some type of dementia. The estimated rate of Alzheimer's also rose greatly with older age—from 2.3% of people aged 71 to 79 to 18.1% of people aged 80 to 89 to 29.7% of those aged 90 and older. The ADAMS investigators found fewer years of education and the presence of at least one APOE e4 allele, a genetic risk factor for AD, to be strong predictors of AD and other dementias.

— Source: The National Institutes of Health

Students are craving accurate information on drug abuse and addiction. That’s the conclusion scientists from the National Institute on Drug Abuse (NIDA) drew from a groundbreaking online chat with high school and some middle school students. In all, there were more than 36,000 questions from schools in 49 states, as well as the District of Columbia, Puerto Rico, the Virgin Islands, and Guam. NIDA is part of the National Institutes of Health.

NIDA partnered with Scholastic, a popular in-school publication service, to promote NIDA’s Drug Facts Chat Day 2007 through school distribution lists. More than 40 scientists and science writers who specialize in addiction issues took turns throughout the day to answer questions as they were posted during a 10-hour period, sometimes as rapidly as 6,000 questions per hour. NIDA Director Nora D. Volkow, MD, herself answered more than 100 questions.

“Reaching people in their teen years with accurate information is one of the most important addiction prevention efforts we can make,” says Volkow. “The unexpectedly high volume of questions in this chat underscores how much this age group wants fact, not rumor; how much they don’t know; and how much their teachers want to help them get the latest in scientific information.”

More than 10% of the questions focused on marijuana, another 10% on alcohol, and another 10% on smoking. More than 600 teens asked how they could get help for a friend, and nearly 400 teens asked about the effects of using drugs or alcohol during pregnancy. There were more than 100 questions on inhalants, including gasoline, permanent markers, and hairspray. At least 50 teens asked about steroids and athletic performance. There were nearly 1000 questions each on methamphetamine and cocaine, more than 300 on heroin, and more than 200 on “shrooms” (mushrooms). Despite recent surveys showing a consistently high rate of nonmedical use of prescription drugs among older teens, there were fewer than 200 questions combined on Vicodin and OxyContin, the most commonly abused medications.

— Source: National Institute on Drug Abuse

Results of a new study may one day help scientists learn how to enhance a naturally occurring mechanism in the brain that promotes resilience to psychological stress. Researchers funded by the National Institutes of Health's National Institute of Mental Health (NIMH) found that, in a mouse model, the ability to adapt to stress is driven by a distinctly different molecular mechanism than is the tendency to be overwhelmed by stress. The researchers mapped out the mechanisms—components of which also are present in the human brain—that govern both kinds of responses.

In humans, stress can play a major role in the development of several mental illnesses, including posttraumatic stress disorder and depression. A key question in mental health research is: Why are some people resilient to stress, while others are not? This research indicates that resistance is not simply a passive absence of vulnerability mechanisms, as was previously thought; it is a biologically active process that results in specific adaptations in the brain's response to stress.

Vulnerability in the mice was measured through behaviors such as social withdrawal after stress was induced by putting them in cages with bigger, more aggressive mice. Even a month after the encounter, some mice were still avoiding social interactions with other mice—an indication that stress had overwhelmed them—but most adapted and continued to interact, giving researchers the opportunity to examine the biological underpinnings of the protective adaptations.

Looking at a specific part of the brain, the researchers found differences in the rate of impulse-firing by cells that make dopamine. Vulnerable mice had excessive rates of impulse-firing during stressful situations. But adaptive mice maintained normal rates of firing because of a protective mechanism—a boost in activity of channels that allow the mineral potassium to flow into the cells, dampening their firing rates. Higher rates of impulse-firing in the vulnerable mice led to more activity of a protein called BDNF, which had been linked to vulnerability in previous studies by the same researchers. With their comparatively lower rates of impulse-firing, the resistant mice did not have this increase in BDNF activity, another factor that contributed to resistance.

Results of the study were published online in Cell, by Vaishnav Krishnan, Ming-Hu Han, PhD, Eric J. Nestler, MD, PhD, and colleagues from the University of Texas Southwestern Medical Center, Harvard University, and Cornell University.

— Source: National Institutes of Health

Schizophrenia may occur, in part, because of a problem in an intermittent on/off switch for a gene involved in making a key chemical messenger in the brain, scientists have found in a study of human brain tissue. The researchers found that the gene is turned on at increasingly high rates during normal development of the prefrontal cortex, the part of the brain involved in higher functions like thinking and decision-making—but that this normal increase may not occur in people with schizophrenia. The study was funded by the National Institutes of Health's National Institute of Mental Health (NIMH) and National Institute of Child Health and Human Development.

The gene, "GAD1," makes an enzyme essential for production of the chemical messenger, called GABA. The more the gene is turned on, the more GABA synthesis can occur, under normal circumstances. GABA helps regulate the flow of electrical traffic that enables brain cells to communicate with each other. It is among the major neurotransmitters in the brain. Abnormalities in brain development and in GABA synthesis are known to play a role in schizophrenia, but the underlying molecular mechanisms are unknown. In this study, scientists discovered that defects in specific epigenetic actions—biochemical reactions that regulate gene activity, such as turning genes on and off so that they can make substances like the GAD1 enzyme—are involved.

The researchers also showed, in mice, that antipsychotic medications like clozapine appear to correct this epigenetic flaw. This raises the possibility of developing new medications aimed at correcting defects in the mechanisms involved. Finding more precise molecular targets for development of new schizophrenia medications is a key effort, because it can lead to more effective treatments with fewer side effects. Clozapine and other current antipsychotic medications are effective for many patients, but not all, and they can cause side effects severe enough that some people choose to stop treatment.

Results of the research were published in a recent issue of the Journal of Neuroscience, by Schahram Akbarian, MD, PhD, Hsien-Sung Huang, PhD student, and colleagues at the University of Massachusetts Medical School and Baylor College of Medicine.

— Source: National Institutes of Health

A video game designed by McGill University researchers to help train people to change their perception of social threats and boost their self-confidence has now been shown to reduce the production of the stress-related hormone cortisol. The new findings appear in a recent issue of the Journal of Personality and Social Psychology. “We already knew that it was possible to design games to allow people to practice new forms of social perception, but we were surprised by the impact this had when we took the games out of the lab and into the context of people’s stressful lives,” says Mark Baldwin, a McGill psychology professor.

Baldwin and his team—McGill PhD graduates Stéphane Dandeneau and Jodene Baccus and graduate student Maya Sakellaropoulo—have been developing a suite of video games that train players in social situations to focus more on positive feedback rather than being distracted and deterred by perceived social slights or criticisms. The games are based on the emerging science of social intelligence, which has found that a significant part of daily stress comes from our social perceptions of the world.

In their recent study, they recruited 23 employees of a Montreal-based call centre to play one of their games, which involves clicking on the one smiling face among many frowning faces on a screen as quickly as possible. Through repetitive playing, the game trains the mind to orient more toward positive aspects of social life, says Baldwin. The call-centre employees did this each workday morning for a week. They filled out daily stress and self-esteem questionnaires and had their cortisol levels tested through saliva analysis on the final day of the experiment. These tests showed an average 17% reduction in cortisol production compared with a control group that played a similar game but without the smiling faces.

“There are many possible applications for this kind of game,” says Baldwin, “from helping people cope with the social anxiety of public speaking or meeting new people, to helping athletes concentrate more on their game rather than worrying about performing poorly.”

— Source: McGill University

The importance of role disability—the inability to work or carry out usual activities—has become increasingly recognized as a major source of indirect costs of illness because of its high economic impact on ill workers, their employers, and society. However, there is limited information on the amount of disability associated with a wide range of specific physical and mental conditions. New findings published by Kathleen Merikangas, PhD, from the National Institute of Mental Health (NIMH) and Ronald Kessler, PhD, from Harvard Medical School and colleagues in a recent issue of the Archives of General Psychiatry show that more than half of U.S. adults have a mental or physical condition that influences their role functioning. In addition, more than 1.3 billion days out of role performance are lost each year in the U.S. due to mental disorders, and major depression is the mental disorder associated with the largest number of days out of role. The study also found that the number of days out of role due to mental disorders is roughly half as large as the number of days associated with all chronic physical conditions combined.

These results are based on the National Comorbidity Survey-Replication (NCS-R), a nation-wide survey of 9,282 Americans ages 18 and older funded by the NIMH. The findings showed that more than half of U.S. adults have a mental or physical condition that is associated with excess days out of role, leading to an estimated 3.7 billion days per year out of role associated with the conditions studied. Nationwide, about 2.4 billion disability days resulted from the chronic physical conditions studied and about 1.3 billion disability days resulted from the mental conditions studied. The effects of individual mental conditions were as large as those of most chronic physical conditions. Chronic back-neck pain was the condition associated with the largest number of days out of role (1.2 billion), followed by major depression resulting in the second largest number of days out of role (387 million).

The researchers suggest that, in light of these results, healthcare resource allocation decisions may need to be rethought. “Previous research has found that, on the whole, the least amount of health resources are spent on research and treatment of musculoskeletal disorders and depression, even though these are the most prevalent and disabling conditions,” says Merikangas. “These results illuminate the discrepancy between how we allocate our healthcare resources, and which illnesses have the most impact.”

— Source: Harvard Medical School

At 30,000 feet, breast cancer awareness is probably not the first thing on an airline passenger’s mind. But Delta Airlines is trying to change all that. Delta’s “Force for Global Good” is offering $2 glasses of pink lemonade to customers and donating all proceeds to The Breast Cancer Research Foundation (BCRF). “Our customers and employees share equal passion about this cause and our commitment to help raise awareness and find a cure for breast cancer,” says Katie Connell, a senior manager at Delta Airlines. “Since 2005 Delta employees and customers have raised more than $400,000 for BCRF through donations, as well as the sale of pink lemonade onboard and pink products.”

While the intentions are clearly philanthropic and good, passengers are reminded that for an extra $3 they can add alcohol to their lemonade. Despite the fact that Delta Airlines is not officially promoting the consumption of alcohol or adding the money from alcohol sales to their fundraising efforts, flight attendants are making the offer. Since heavy drinking is an established risk factor for breast cancer, the message of awareness might be blurred. “On two recent flights, I was struck by the irony of breast cancer prevention messages being immediately followed by a reminder that you could add alcohol to the drink,” says Richard Schmitz, director of communications, for the Society for Women’s Health Research. “One flight attendant delighted at suggesting over the speaker system that you could add vodka to make a pink martini of sorts. I think it is a mixed message.”

A study by Kaiser Permanente presented at the European Cancer Conference in September found that women who consume more than three drinks a day face a 30% increase in breast cancer risk compared with women who consume less than one drink a day. Women who drank one or two drinks a day had a 10% increase in breast cancer risk. These results could be confusing because several well-publicized studies also have indicated that consumption of wine protects against heart disease. Women may assume that choosing wine is healthier than beer or hard liquor, but for breast cancer risk, it really comes down to the amount of alcohol consumed, rather than the type. “The risk is present for any type of alcohol,” explains Patrick Maisonneuve, MD, chairman of epidemiology at the European Institute of Oncology in Italy.

Alcohol seems to be an underestimated risk factor for breast cancer and the exact mechanism of how alcohol contributes to the development of breast cancer is not fully understood. Many studies suggest that hormones could be involved. According to Maisonneuve, “alcohol may elevate levels of estrogen, prolactin and other hormones potentially associated with a higher breast cancer risk.” Heavy consumption of alcohol may activate this mechanism, placing women who drink on a regular basis at higher risk for breast cancer. “I think the efforts of Delta and other companies to raise awareness of and money for important health conditions should be applauded,” Schmitz says. “I just want to make sure that women are mindful of the health risks they face and the factors that can increase those risks.”

— Society for Women's Health Research

A new Carsey Institute Fact Sheet shows that working Americans in rural areas are more likely to benefit from the Earned Income Tax Credit (EITC) to make ends meet than their neighbors in urban areas. Families in the rural South take advantage of the tax credit the most. The study, “EITC is Vital for Working-Poor Families in Rural America,” finds that while only 16% of U.S. tax filers in 2004 were from rural areas, rural EITC filers claimed 20% of the $39.8 billion EITC funds. In 2004, rural EITC recipients collectively received $7.8 billion through the credit. The vast majority of EITC dollars go to working families with children who have earnings below $35,000 a year.

“The amount of money received by the average rural family ($1,850) may not seem like much to more affluent families, but for low-income families it can be an enormous help. Research shows that for kids growing up in low-income families, even a small boost in income can lead to better child outcomes,” says study authors William O’Hare, rural fellow with the Carsey Institute, and Elizabeth Kneebone, research analyst with the Brookings Institute. “As Congress entertains legislation to expand the EITC program, it is important to recognize how vital this program is for low-income families in rural America,” the authors say.

— Source: University of New Hampshire

If the care received by vulnerable older people concurrently enrolled in Medicare and Medicaid was evaluated on a grading scale, it would squeak by with a barely passing mark, a new University of California, Los Angeles (UCLA) study has found. Using quality-of-care measurements developed by the Assessing Care of Vulnerable Elders project, researchers found that vulnerable older adult patients received only 65% of the tests and other diagnostic evaluations and treatments recommended for a variety of illnesses and conditions, including diabetes and heart disease. The study findings appear in a recent issue of Medical Care.

"Thirty-five percent of the medical care interventions that they should have received were not provided, indicating significant room for improvement," says lead author David S. Zingmond, MD, PhD, an assistant professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. "We'd much rather have everything higher—say, at least 90%." The researchers gathered data from 100,258 community-dwelling geriatric patients in 19 California counties between 1999 and 2000. Using linked Medicare and Medicaid data from the California Center for Long Term Care Integration—a collaborative effort between the UCLA Division of Geriatrics and the University of Southern California School of Gerontology—researchers examined quality for 43 specific types of care (for example, receiving a new medication or having a diagnostic test) for common conditions such as depression, diabetes, hypertension and heart failure.

They found that in too many instances, older adult patients were not given the full range of treatments and services for their conditions. For example, only 42% of patients with diabetes were tested to gauge their blood sugar control or received an eye examination during the one-year study period. Likewise, many patients who were newly diagnosed with heart failure did not receive recommended diagnostic evaluations or medications known to be effective. "The Medicare and Medicaid administrative data contain information on many aspects of the care that these patients receive," he says. "This type of monitoring is both feasible and necessary."

— Source: University of California, Los Angeles, Health Sciences

The combination of the antidepressant medication fluoxetine and cognitive behavior therapy appears more effective than either strategy alone for the long-term treatment of adolescents with depression, according to a report in a recent issue of Archives of General Psychiatry. To improve the treatment of depression in teens, the National Institute of Mental Health (NIMH) in 1999 funded the Treatment for Adolescents with Depression Study (TADS). The TADS team randomly assigned 439 adolescents with depression to one of the three treatments or to placebo pills for 12 weeks. After 12 weeks, 73% of patients receiving combination therapy, 62% of those receiving only fluoxetine, and 48% of those only undergoing cognitive behavior therapy responded to treatment, as measured by two clinical scales. At the end of 36 weeks, 243 (74.3%) of the 327 patients remained in the study.

Throughout treatment, researchers monitored patients for suicidal thoughts and behaviors. At the beginning of the study, 42 of 106 (39.6%) of those in the combination therapy group, 28 of 107 (26.2%) of those in the fluoxetine group and 27 of 107 (25.2%) of those in the cognitive behavior therapy group warranted prompt evaluation for suicidal tendencies. By week 12, patients treated with fluoxetine alone reported more clinically significant suicidal thoughts and behaviors than those in either of the groups receiving cognitive behavior therapy. After 36 weeks, two of 79 (2.5%) combination therapy patients, 10 of 73 (13.7%) taking fluoxetine alone, and three of 76 (3.9%) receiving cognitive behavior therapy reported experiencing significant suicidal thoughts and behaviors.

Suicidal events—defined as suicidal attempts, thoughts and behaviors or preparatory actions toward suicide—occurred in 10% of patients in the study, mostly early in treatment. “Patients treated with fluoxetine alone were twice as likely as patients treated with combination therapy or cognitive behavior therapy to experience a suicidal event, indicating that cognitive behavior therapy may protect against treatment-emergent suicidal events in patients taking fluoxetine,” the authors write. “After taking benefit and risk into account, we conclude that the combination of fluoxetine and cognitive behavior therapy appears superior to either monotherapy [single treatment] as a long-term treatment strategy for major depressive disorder in adolescents.”

— Source: American Medical Association

Alcohol-dependent patients who received the medication topiramate had fewer heavy drinking days, fewer drinks per day, and more days of continuous abstinence than those who received placebo, according to a study in a recent issue of the Journal of the American Medical Association. Bankole A. Johnson, DSc, MD, PhD, of the University of Virginia, Charlottesville, Va., and colleagues conducted a multisite, 14-week, randomized, controlled trial to determine the efficacy of topiramate compared with placebo. The study, which included 371 men and women aged 18 to 65 diagnosed with alcohol dependence, was conducted between January 2004 and August 2006 at 17 U.S. sites. The participants received up to 300 milligrams per day of topiramate (n = 183) or placebo (n = 188), along with a weekly psychosocial treatment to promote adherence with the study medication and the treatment regimen.

Treating all dropouts as relapse to baseline, topiramate compared with placebo recipients showed greater reduction of percentage of heavy drinking days from baseline to week 14 (from an average of 81.9% to 43.8% for topiramate vs. 82% to 51.8% for placebo; average difference, 8.44%). Prespecified analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (average difference, 16.19%). The researchers also found that topiramate compared with placebo treatment was associated with a significantly higher rate of achieving 28 or more days of continuous nonheavy drinking and 28 or more days of continuous abstinence. Adverse events that were more common with topiramate vs. placebo included paresthesia, taste perversion, anorexia, and difficulty with concentration.

“Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the U.S. and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings,” the authors conclude.

— Source: American Medical Association

A study by University of Virginia psychology professor Shigehiro Oishi and colleagues at three other institutions found that, on average, European-Americans claim to be happy in general—more happy than Asian-Americans or Koreans or Japanese—but are more easily made less happy by negative events, and recover at a slower rate from negative events, than their counterparts in Asia or with Asian ancestry. On the other hand, Koreans, Japanese, and to a lesser extent, Asian-Americans, are less happy in general, but recover their emotional equilibrium more readily after a setback than European-Americans, according to the study in the Journal of Personality and Social Psychology.

"We found that the more positive events a person has, the more they feel the effects of a negative event," Oishi says. He and his colleagues surveyed more than 350 college students in Japan, Korea, and the United States over a three-week period. The students recorded daily their general state of satisfaction or dissatisfaction with life, as well as the number of positive and negative events they had during the course of each day.

Oishi says that people who become accustomed to numerous positive or happy events in their life are more likely to take a harder fall than people who have learned to accept the bad with the good. And because negative events have such a strong effect when occurring in the midst of numerous positive events, people find it difficult to be extremely happy. They reach a point of diminishing returns. "In general, it's good to have a positive perspective," Oishi says. "But unless you can switch your mindset to accept the negative facts of everyday life—that these things happen and must be accepted—it becomes very hard to maintain a comfortable level of satisfaction."

— Source: University of Virginia

Joshua Smyth, associate professor of psychology in The College of Arts and Sciences at Syracuse University, recently conducted a randomized trial study of college students contrasting the effects of playing online socially interconnected video games with more traditional single-player or arcade-style games. While both multiplayer and traditional single player video games present a double-edged sword, Smyth’s research found that online, socially integrated multiplayer games create greater negative consequences (decreased health, well-being, sleep, socialization and academic work) but also garner far greater positive results (greater enjoyment in playing, increased interest in continuing play and a rise in the acquisition of new friendships) than do single-player games. The study is published in a recent issue of the bimonthly peer-reviewed journal CyberPyschology & Behavior.

“Students in the study who played online multiplayer games did so about three times as much as those playing single-player game types, averaging over 14 hours a week,” says Smyth. In his study, Smyth randomly assigned 100 college student volunteers to play one of four types of video games: arcade-style games; console games; single-player computer games; and fantasy-themed persistent online multiplayer games. “Video game play does interfere in some aspects of real-life—such as academic performance, health and social life—but game play can also foster strong feelings of virtual support and new friendships,” Smyth says.

— Source: Syracuse University

Inhaling, or "huffing," the vapors of common household solvents strongly correlates with suicidal thoughts and behavior among adolescents. That’s what researchers found in a study of 723 incarcerated youth—the first work to categorize inhalant use into levels of severity and relate this to suicidal ideas and suicide attempts in incarcerated juveniles. It is also one of the few studies to examine gender differences involved. It was written by Stacey Freedenthal, PhD, and Jeffrey M. Jenson, PhD, both of the University of Denver’s graduate School of Social Work, Michael G. Vaughn, PhD, of the University of Pittsburgh, and Matthew O. Howard, PhD, of the University of North Carolina, and appears in a recent issue of the academic journal Drug and Alcohol Dependence.

The investigators found an increase in suicidal thoughts and attempts with higher levels of use of volatile solvents. In fact, the majority of those in the sample who had been serious abusers prior to incarceration reported having tried to kill themselves at some point. The researchers did not seek to determine which problem came first, the huffing or the suicidal behavior, but showed that the two are connected, even when accounting for other factors. The study points out that suicide is the third leading cause of death among adolescents in the United States, and that the rates of suicide attempts appear to be very much higher for those who use inhalants than for those who do not. The study categorized inhalant use into three levels: no use, use without dependence or abuse, and use with a diagnosis of dependence or abuse. The research controlled for factors such as alcohol and other drug use, psychiatric disturbances, and trauma to see if these accounted for the suicidal behavior, but the link specifically between higher levels of inhalant use and suicidal behavior remained distinct for both genders.

The most startling numbers related to girls, revealing a history of suicide attempts among 81.3% of those who abused or were dependent on inhalants, with boys in the same category at 59.5%. "Girls' problems tended to be more severe," Freedenthal says. "For participants who reported dependence or abuse of inhalants, rates of suicide attempts were dramatically higher for girls. However, prior research indicates that while girls attempt suicide more often than boys do, boys actually die by suicide at higher rates." The study also indicated that suicidal thoughts were much higher for girls than for boys. Suicidal thoughts and attempts were considered two separate constructs, since thoughts do not always lead to attempts, and attempts are not always preceded by much thought.

The study involved 723 participants incarcerated by the Missouri Division of Youth Services, 33% of whom reported having inhaled volatile solvents. Twenty-five percent had attempted suicide, and 58% reported suicidal thoughts. Fifty-three percent were from urban or suburban environments, and 47% were from rural areas or small towns. Fifty-five percent were white, 33% were black, and nearly 12% were other races. There were 629 boys and 94 girls. The average age was 15.

— Source: Dick Jones Communications

High-risk teenagers who participate in peer-led substance abuse prevention programs reduce their drug use by approximately 15% versus traditional curricula, suggests a study led by researchers at the University of Southern California (USC), which appears in the journal Addiction.

“Most substance abuse prevention programs disseminate information about the bad effects of drugs and teach resistance skills without considering the impact of peer influence,” says Thomas Valente, PhD, assistant professor of preventive medicine at the Keck School of Medicine of USC. “Generally, our study emphasizes the power of peers. We found that social network-tailored prevention curricula can be very successful in achieving long-term behavioral changes in teenagers.”

The study compared substance use among students participating in the prevention program Project Towards No Drug Abuse (TND), traditionally led by a health educator or teacher, with the modified peer-led Project TND Network. TND held interactive discussions at the classroom level while TND Network divided the students into smaller groups composed of their friends, increased the number of group activities and a student-chosen leader led the discussion.

Approximately 550 students from 14 alternative high schools in southern California completed surveys given before the program and again approximately one year later. The average age of the participants was 16. The study assessed data on their use of tobacco, alcohol, marijuana and cocaine. Students were randomly assigned by classroom to receive one of the two curricula or the control group.

“Reducing drug use among the high-risk teen population at these alternative schools is tough,” continues Valente. “It is encouraging to see this type of positive influence among students who live and go to school in challenging environments.” However, the study also found that students with a peer environment that supports substance use did not benefit from the interactive program. Students with substance using friends increase their own use in the peer-led condition.

“Peer influence can go both ways, some students benefited because of the positive social influence of their friends while others were harmed by negative influence of their substance using peers,” concludes Valente. “Programs that incorporate this type of interactive programming can be very effective, but they depend on how peer influence is channeled. ”

— Source: University of Southern California Health Sciences

A multi-institution team led by University of Southern California (USC) faculty has received a five-year, $8.4 million grant from the National Institutes of Health (NIH) for an ambitious effort to survey the genetic, physical, and behavioral profiles of children with autism. The grant vastly will increase the reach and ethnic diversity of the Autism Genetic Resource Exchange (AGRE), the world’s largest database for autism research, overseen by Clara Lajonchere, research assistant professor at the USC Viterbi School of Engineering with a joint appointment at the Keck School of Medicine of USC.

Lajonchere, who serves as vice president of clinical programs for Autism Speaks, says: “This reaffirms the NIH’s commitment to supporting the AGRE resource, the largest repository of clinical and genetic information for families with two or more kids with autism. AGRE represents a paradigm shift towards large-scale collaboration and data sharing in the research community.” The NIH grant will double the number of families in AGRE and expand the data beyond genetic and clinical profiles to include what the researchers call phenomics: the systematic study of the outward physical and behavioral marks of autism. The research will be organized under a new Center for Genomic and Phenomic Studies in Autism. One goal of the new center, says Thomas Lehner, chief of the NIH Genomics Research Branch, is to better distinguish among the many forms of autism and to explore the differences in their genetic profiles.

“We are trying to establish a correspondence between gene and phenotype, with the phenotype being autism and its many manifestations,” Lehner says. “A unique feature of this grant is the extensiveness of phenotyping. This is one of our largest projects, if not the largest.” AGRE’s expansion will focus on recruiting an ethnically diverse group of families, since Caucasians have been over-represented in genetic studies to the point that diagnostic tools are unreliable for minorities, Lajonchere says. “There are few focused genetic studies that directly examine minority populations,” she says. The center’s expansion will complement efforts by Lajonchere and colleagues at Autism Speaks to foster similar studies in other countries.

— Source: University of Southern California Health Sciences

In the largest private donation to a school of social work in the United States, Constance and Martin Silver have pledged $50 million to the New York University School of Social Work. The gift will be used to support the Constance McCatherin-Silver Fellowship, which provides financial aid to MSW students in need who are dedicated to helping minority populations; to establish an endowed professorship for a junior faculty member researching poverty; and to promote other new initiatives dedicated to the study of poverty and to better allocate funding, administration, and services.

The funds also will help lay the groundwork for a planned McSilver Institute for Policy and Research. ("McSilver" is a combination of Silver's name and her maiden name, McCatherin.) In recognition of this historic gift, the NYU Board of Trustees has renamed the School as the Silver School of Social Work.

Both Silvers are alumni of NYU. Constance Silver earned a BS in social work in 1978 and an MSW in 1979; she also received a PhD from the Union Institute and University in 1983. Martin Silver is a 1958 graduate of NYU's School of Commerce (now the Stern School of Business).

"This gift marks a new chapter in the life of our school, and in a larger sense, it is an unprecedented moment for social work education," says Suzanne England, dean of the School of Social Work at NYU. "The research, learning, and policy work sustained by the Silvers' generosity will help deepen our knowledge about systemic poverty, and identify effective policies to lessen or eliminate its causes."

Constance Silver, who taught at the school for several years, says "It is one of the great pleasures of my life to help the School of Social Work, and Martin is proud to be able to offer his support to the school as well."

— Source: New York University School of Social Work

Cedric Willis of Jackson, MS, was convicted in 1997 of murder and robbery and sentenced to life in prison despite the fact that DNA evidence excluded him as the perpetrator. Thanks to help from the Innocence Project of New Orleans, Willis was granted a new trial, found innocent and freed from prison in 2006. To help those like Willis who are serving time for crimes they did not commit, the Mississippi Innocence Project at the University of Mississippi School of Law was announced last spring. Initial funding for the project came from Grisham and Columbus attorney Wilbur Colom, a graduate of Antioch Law School.

It is stories like Willis’ that fuel the desires of those working with the Mississippi Innocence Project, including its director Tucker Carrington, formerly a visiting professor at Georgetown Law School. Carrington says the program is committed to providing legal representation to its clients: state prisoners serving significant periods of incarceration who have cognizable claims of wrongful conviction. Throughout the fall semester, the project will continue to identify and investigate other potential cases, and by January 2008, plans call for it to become an integral part of the law school’s course offerings. In addition, college and university students from around the state who are studying law and journalism are to be involved in investigating the cases. Besides serving its clients, the project seeks to identify systemic problems in the state’s criminal justice system and develop initiatives designed to raise public and political awareness of the prevalence, causes and societal costs of wrongful convictions, Carrington says.

Emily Maw, director of the Innocence Project of New Orleans, says such projects are important because “like it or not, our criminal justice system incarcerates innocent people for very long prison terms.” There have been 207 post-conviction DNA exonerations in the United States since 1989 and well over 200 additional post-conviction exonerations that involved other more-traditional evidence of innocence, she says. “If it were not for innocence projects, there would be virtually no way for innocent prisoners to get legal help to get out of prison,” she says. “State prisons in Louisiana and Mississippi contain almost exclusively poor people. Therefore, the innocent amongst them cannot afford to hire a lawyer to prove their innocence and a very large percentage of prisoners in both states are functionally illiterate, so even if they weren’t stuck behind razor wire, they wouldn’t be able to advocate for themselves.”

— Source: University of Mississippi

A study of middle-school students in central Illinois has found that being called antigay names significantly predicts higher levels of trauma for students regardless of sexual orientation. Such name-calling may lead to anxiety, depression, personal distress, and a lower sense of school belonging. “These results are another indication that verbal bullying in schools should not be tolerated,” says Robert-Jay Green, PhD, executive director of the Rockway Institute at Alliant International University. “Unfortunately, antigay name-calling is often viewed by adults as part of growing up and is tolerated by school officials, but this study finds the behavior is damaging to all students.” The study, “Predicting Psychosocial Consequences of Homophobic Victimization in Middle School Students,” was conducted by V. Paul Poteat and Dorothy L. Espelage of the University of Illinois at Urbana-Champaign and published in The Journal of Early Adolescence.

Among a group of 143 seventh graders, Poteat and Espelage examined the extent to which being the target of antigay name-calling over a one week period predicted psychological effects after controlling for students’ previously reported levels of psychological functioning. In seventh grade, these students reported their level of anxiety, depression, school belonging, and social withdrawal. The students were surveyed again a year later, when they were in the eighth grade, and they again reported these conditions as well as the frequency with which they were called homophobic epithets by other students. The sexual orientation of the students was not known, but it was assumed that the vast majority of students were heterosexual.

The results indicate that “being the victim of homophobic name-calling is a serious concern and significantly predicts several negative psychosocial outcomes,” state the researchers. Also, there were differences between the sexes. For males, being the recipient of name-calling was significantly linked with anxiety, depression, personal distress, and a lower sense of school belonging. For females, being the object of name-calling was connected with higher levels of social withdrawal. The authors of the study concluded: “Existing research has underscored the traumatizing effects of homophobic victimization for gay and lesbian students, and this investigation suggests that homophobic victimization can also be detrimental to heterosexual students, further underscoring the relevancy of this issue for teachers, administrators, and school counselors.”

— Source: Alliant International University

“Schools have a tendency to close for the entire week (after a shooting incident) which I am generally opposed to,” says Scott Poland, EdD, professor of psychology at Nova Southeastern University in Fort Lauderdale, FL, and the author of four books on school crises. “At the very least schools should be open for counseling the day after. Let kids and parents know that teachers and counselors are there and it won’t be a regular academic day but kids can come in and get help,” says Poland who has served on national crisis teams after numerous school shootings including those in Littleton, CO, and Red Lake, MN.

About 60% of students bounce back after school shootings with little or no psychological damage, Poland says. Another 20% will suffer minor psychological problems. A final 20% are at risk for major problems. “What needs to happen is a psychological triage,” he says. “There are three circles of vulnerability. The first circle includes those students and staff who were in close physical proximity to the shootings. The second circle includes those who were in close social proximity to the shooting victims—people who were their close friends or roommates, for example. The third circle is comprised of people who have had a history of trauma or violence in their family.”

Poland says the problem in the immediate aftermath of school shootings is that people focus on why the massacre occurred instead of what the survivors need. “We never seem to get much of an explanation as to why—and there is always a lot of second-guessing about what could have been done differently. But the most frustrating thing about that is that we need to focus on the mental health and psychological needs of the people who have been through the experience.”

— Source: Dick Jones Communications

Children with older delinquent siblings are at high risk for becoming juvenile delinquents themselves. Researchers have been studying family interventions that prevent young high-risk children from following in the footsteps of their older siblings. Now a new study shows that a non-medical early family intervention that improves caregiving also results in important changes in children’s biological response to stress.

Delinquent adolescents and highly aggressive children have been shown to have abnormal stress responses, especially in social situations. They appear to be less tuned in to social cues and they are not as sensitive to positive reinforcement as normally developing children, explains Laurie Miller Brotman, PhD, the lead author of the study and the Corzine Family Associate Professor of child and adolescent psychiatry at NYU School of Medicine. A family intervention that results in an adaptive stress response in young high-risk children may prevent delinquency and psychiatric illness later in life.

“Our findings demonstrate the powerful influence of the caregiving environment on children’s biology,” says Brotman. “We have known for some time that parents play an important role in how young children behave. We have shown that parents of delinquent youth can improve their parenting and these changes result in lower rates of problems in their young children. We have now documented that a program that improves parenting and children’s behavior also leads to biological changes that are consistent with more adaptive non-delinquent behaviors.”

“We are really excited by these findings,” says Brotman, who is also director of the Institute for Prevention Science at NYU Child Study Center “They suggest that antisocial behavior isn’t hard wired and parents can be part of the solution.”

— Source: New York University Medical Center

Compared with advancements in modern medicine over the past 70 years, there have been few new treatment options for people who stutter. That’s one reason a $50 digital device being developed by a University of Mississippi researcher is drawing attention. Contrast that price to a typical digital speech device costing approximately $5,000, and it’s easy to see why Greg Snyder, assistant professor of communicative disorders, may be on to something big. Snyder says that his own experience as a person who stutters played an important role in his chosen goals as a researcher and educator. “There is an incredible amount of disinformation and poor theory in stuttering research and treatment,” Snyder says. “Most of the ‘common knowledge’ thought by the public and even within the field isn’t based on science, but rather people’s ‘common sense’ prejudice.”

Snyder’s research has led him to develop a system using portable MP3 players to take the place of expensive and nearly invisible digital speech feedback prosthetic devices. His work has drawn national attention. Snyder says that it has been known since the early 1950s that Delayed Auditory Feedback enhances fluent speech in those who stutter. “Because the current paradigm believed—and still largely believes—that stuttering is a psychological problem, many professionals continue to believe that this speech feedback ‘distracts’ people from their stuttering, thus enhancing fluent speech,” he says. “Other professionals believe that the speech feedback slows down the rate of speech, thus enhancing fluent speech. Both of these premises are not easily supported with science. However, there is an emerging group of researchers who realize that speech feedback might work by altering the way the brain processes speech.”

Using this theory, researchers at East Carolina University developed an in-the-ear feedback device. However, while it has the advantage of being the size of a hearing aid, it can cost up to $4,900. Snyder determined that many people who stutter may only need an external source of speech initiation to address their problem. Those realizations coupled with the then-emerging technology of hand-held digital music devices led to his current line of research. “The results were pretty promising. While it’s not a cure, it worked on 80% of the participants,” he says. In fact, 40% of research participants found significant fluency enhancement while using the device; the other 40% found it effective but probably not enough to endure the nuisance of the constant vowel sounds. “This device certainly will not cure stuttering or the problems of stuttering, but it may improve the quality of life for some people who stutter,” Snyder says.

— Source: University of Mississippi

Daily television viewing for two or more hours in early childhood can lead to behavioral problems and poor social skills, according to a study of children aged 2.5 to 5.5 conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. The Hopkins researchers found that the impact of TV viewing on a child’s behavior and social skills varied by the age at which the viewing occurred. More importantly, heavy television viewing that decreased over time was not associated with behavior or social problems. The American Academy of Pediatrics recommends that children under age 2 watch no television while children age 2 and older are limited to no more than two hours of daily viewing. The study is published in a recent issue of Pediatrics.

“A number of studies have demonstrated negative effects of heavy television viewing. However, timing of exposure is an important consideration as reducing viewing to acceptable levels can reduce the risk of behavioral and social problems,” says Kamila Mistry, MPH, lead author of the study and a doctoral candidate in the Bloomberg School’s Department of Population, Family and Reproductive Health. For the study, the research team analyzed data for 2,707 children collected from the Healthy Steps for Young Children national evaluation. Parents were surveyed about their child’s television viewing habits and behavior at age 2.5 and 5.5.

Sixteen percent of parents reported that their children watched two hours or more of television daily at age 2.5 (early exposure), while 15% reported that their children watched two hours or more of television daily at age 5.5 (concurrent exposure). One in five parents reported that their children watched two hours or more of television daily at both age 2.5 and 5.5 (sustained exposure). Sustained exposure to television was associated with behavioral problems. However, early exposure that was subsequently reduced was not a risk for behavior problems. Concurrent viewing was associated with fewer social skills, while sustained and early viewing had less of an impact on social skill development. The study also found that having a television in the child’s bedroom at age 5.5 was associated with behavioral problems and poor sleep. Forty-one percent of the children included in the study had a television in his or her bedroom.

“Children who reduced their viewing by 5.5 years of age were not at greater risk for behavior and social problems,” says Cynthia Minkovitz, MD, MPP, senior author of the study and associate professor with the school’s department of population, family and reproductive health. “It is vital for clinicians to emphasize the importance of reducing television viewing in early childhood among those children with early use.”

— Source: Johns Hopkins Bloomberg School of Public Health

Until now, there has been little research on the best ways to care for geriatric patients with bipolar disorder. Now, a major National Institute of Mental Health (NIMH)–funded multi-site clinical research study—led by the Weill Cornell Institute of Geriatric Psychiatry at NewYork-Presbyterian Hospital/Westchester division—is the first to compare the efficacy of two commonly used mood stabilizers for geriatric patients suffering from the episodes of symptoms that characterize bipolar disorder, formerly known as manic-depressive illness.

Participating in the ongoing study are patients aged 60 and older whose bipolar disorder has been treated with carefully monitored dosages of either lithium or valproate. To date, more than 80 patients at six study sites, including 19 at NewYork-Presbyterian/Westchester, have participated. Known as Geri-BD (Geriatric Bipolar Disorder), the NIMH study is being led by Robert C. Young, MD, a professor of psychiatry at Weill Cornell Medical College with more than 30 years of clinical and research experience, and his colleagues at the Institute. Young's focus has been the development of information to improve the pharmacological management of older adults suffering severe mood disorders.

Young notes that the Geri-BD study is intended to fill a gap, noting that "evidence-based guidelines for older bipolar patients are critically needed, given the increase in the over-60 age group." About 10 million Americans—or approximately 3.3% of the total population—have been diagnosed with bipolar disorder. The American Psychiatric Association estimates that the number of elderly patients with bipolar disorder will grow significantly over the next few decades. Young adds: "To date, most bipolar disorder treatment studies have been conducted in younger patients. However, in some aged bipolar patients, a good symptom response is difficult to achieve, and the mortality rate in elder bipolar patients is relatively high. We hope that findings from this study will help physicians better manage the care of their geriatric bipolar patients."

Over the course of this nine-week study, Geri-BD participants are closely monitored by a psychiatrist who checks their mood state at each visit, assesses any side effects and measures the level of medication in their blood. "We're finding that studying older adults with bipolar disorder under standardized treatment is feasible and can be well tolerated," Young explains.

— Source: NewYork-Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College

New research in primates suggests that infants and children who carry a certain gene variant may be more vulnerable to the ill effects of fetal alcohol exposure. Reported in Biological Psychiatry, the findings represent the first evidence of a genetic risk for fetal alcohol spectrum. By identifying a genetic marker that might signal susceptibility to these more subtle fetal alcohol-induced problems, the research fills a pressing need, says Mary Schneider, the University of Wisconsin (UW)-Madison professor of kinesiology and psychology who led the study. "The big concern used to be the link between fetal alcohol exposure and mental retardation, but today there is increased concern over behavioral problems in these children," says Schneider. "If this genetic marker could provide a way of recognizing the most vulnerable fetal alcohol-exposed children early in life, perhaps we could help them to live more successful and satisfying lives."

The study's results may also help to explain why some children of mothers who drink during pregnancy suffer birth defects, while others seem to escape unharmed. "Children who are exposed to alcohol because their mothers drank during pregnancy have varying degrees of problems, and the same is true for monkeys who are exposed to moderate levels of alcohol in utero," says Schneider. "So we know there are other factors involved." With colleagues at UW-Madison, the University of Toronto, and the National Institutes of Health, Schneider investigated two forms of a gene called the serotonin transporter gene promoter, which helps regulate the brain chemical serotonin. Past studies of both people and primates suggest that carriers of a short form of this gene are at increased risk for depression, but only if they also experience adverse life events.

"We know that 60% of women of child-bearing age consume alcohol and more than 50% of pregnancies are unplanned," she says. "So it doesn't take much to figure out that prenatal exposure to alcohol—at least in the weeks before pregnancy is detected—is substantial." In line with this, the mother monkeys in the study's experimental group consumed the equivalent of just two alcoholic beverages five times a week during breeding and pregnancy. After the infants were born, the scientists recorded their irritability during a standard battery of developmental tests, measured their reactivity to stress when separated from their mothers at six months for weaning, and determined whether they carried the short or long form of the serotonin transporter gene promoter.

What the researchers found is that fetal alcohol-exposed infants who carried a copy of the short form were more irritable and reactive to stress than either control group infants who weren't exposed to alcohol or those who were exposed but had two copies of the gene's long form. Overall, says Schneider, the results indicate a "substantial interaction" between fetal alcohol exposure and genotype. Recognizing that complex behaviors are seldom, if ever, governed by a single gene, Schneider and her colleagues are also investigating other gene alleles for their potential to interact with fetal-alcohol exposure and put children at risk.

— Source: University of Wisconsin-Madison

New research indicates that being victimized because of sexual orientation is a chief risk factor for suicidal behavior among gay, lesbian, and bisexual college students. The study is the first to explore the link between victimization and suicidal behavior among college students. In the course of the study, University of Washington (UW) researcher Heather Murphy also uncovered a group of students who previously had not been studied and are at increased risk for suicidal behavior. These students identified themselves as heterosexual, but also reported being attracted to people of the same sex or engaging in same-sex behavior.

This group was three times as likely as heterosexuals to have made a plan to commit suicide in the past year and six times more likely to have actually attempted suicide in the same period. Gay, lesbian, and bisexual students also were at increased risk for suicidal behavior. They were twice as likely as heterosexuals to have planned and to have attempted suicide in the previous year. The research was based on questionnaires containing 86 questions answered anonymously by more than 500 undergraduate UW students. Fifty-six of those students said they had seriously considered suicide in the previous 12 months. A dozen of them attempted suicide. Two students required medical treatment and recovered. One half of the suicide attempts and both of the cases requiring medical attention involved same-sex attracted heterosexuals.

The study was provoked by a question from a 15-year-old gay male while Murphy was working on an internship as a school psychologist at a high school. The youth, who was suicidal and using drugs, asked her, “Does it get better in college?” She didn’t know. To find out Murphy recruited 528 participants—404 heterosexuals; 79 same-sex attracted heterosexuals; 38 gays, lesbians, and bisexuals; and 7 who said they were not sure of their sexual identity. The students ranged in age from 17 to 26, with a mean age of 19, and 63% of them were female.

Data from the questionnaires showed that gay, lesbian and bisexuals and the same-sex attracted heterosexuals experienced significantly more verbal and physical victimization than did heterosexual students. Verbal victimization included homophobic statements; hearing others talk about gays, lesbian, and bisexuals in derogatory terms; and being harassed for their sexual orientation. Physical victimization included being physically threatened or assaulted and getting into fights. Murphy said victimization for some students was “pervasive” on campus while others didn’t want to go off campus because they feared being harassed or would only visit areas of Seattle popular with gays in groups.

“There is a lot of hype that gay kids are more suicidal,” she says. “My study shows that this is not so. In my study, being victimized for being gay was the risk factor that increased suicidal-behavior risk.”

— Source: University of Washington

Hallmarks of autism are characteristic behaviors that occur in widely different combinations and degrees of severity among those who have the condition. But how those behaviors change as individuals progress through adolescence and adulthood has, until now, never been fully scientifically documented. In a new study, published in a recent issue of Journal of Autism and Developmental Disorders, researchers have found that symptoms can improve with age. "On average, people are getting better," says Paul T. Shattuck, assistant professor of social work at Washington University in St. Louis, who worked on the study as a graduate student and post-doctoral fellow at the University of Wisconsin-Madison's (UW) Waisman Center and is the first author of the paper. "It is a hopeful finding, but the fact remains that those with severe autism will depend on others for their everyday needs and care for the rest of their lives."

Autism is a widespread condition in the United States, affecting an estimated one in 150 children and an unknown number of adults. The new publication is part of a groundbreaking longitudinal study of more than 400 adolescents and adults with autism and their families led by Marsha Mailick Seltzer, a Wisconsin professor of social work and the director of the UW-Madison Waisman Center. "This project is one of the largest long-term studies of autism and it represents the collaborations of a team of researchers who together are investigating how autism changes across the life course," Seltzer explains.

Half of the study's participants are from Wisconsin and half are from Massachusetts. They were recruited from service agencies, schools and clinics. Every 18 months, parents in the study are interviewed in depth to assess changes in their child's symptoms and behaviors. The new paper reports on how behavior in 241 adolescents and adults, initially aged 10 to 52 years, changed over a five-year period. Although symptoms for many in the study remained stable, a significant proportion exhibited improvements in symptoms and maladaptive behaviors. "For all major symptoms, the percentage of people who improved was always greater than the percentage who worsened," Shattuck says. "If there was significant symptom change over time, it was always in the direction of improvement, though there was always a group in the middle that showed no change. The mean never went down."

Like most people, individuals with developmental disabilities such as autism continue to grow and change over time, Shattuck explains. "Their development is not frozen in time and forever the same. That's just not the case." Of those in the study, 69% were also classified as having mental retardation. "Not everyone on the autism spectrum is mentally retarded," Shattuck says, "but being mentally retarded reduces the likelihood of improvement for many symptoms." Why some in the sample improved is being investigated as part of the ongoing study, according to Shattuck. "Our study demonstrates that significant changes are occurring," he explains. "But in terms of the underlying biological mechanisms, we don't yet know what's going on."

— Source: University of Wisconsin-Madison

By Grace Sotirakis, LMSW

He had walked into the ER at 4 a.m., crying uncontrollably. A deaf mute, unable to verbalize, the staff presumed that he was in pain. They soon discovered that he had the ability to read lips to some degree. He shook his head vigorously when asked if he was in pain. Another shake and more sobs when asked if he had ID. Yes, he could write his name—"JOHN" he wrote in large block letters. No, he could not write his address or phone number.

John was a big guy—about 6 feet tall, 250 pounds. He appeared slightly disheveled, in need of a shower and shave. Seated patiently on a gurney, his thick legs dangling over the side, he watched the ER nurse discuss his situation with me.

I walked over to him and introduced myself, taking care to form the words, "social worker." John promptly stood, towering over my 5', 120 pound frame. He pulled a key ring from his pants pocket and shook two keys frantically in my face while emitting a series of grunts and screeches.

"Are those your house keys?" I asked lamely. John, shook his head, continuing to rattle the keys at me. "Can you write down your address?" I asked, handing him my notebook. In his frustration, John flung the keys on the floor and sat down heavily on the gurney.

He began to sob once more, pushing my notebook back at me and shaking his head. "Okay, it's okay, John," I was feeling quite helpless by now. I turned to the nurse who had been standing by quietly. "Did anyone check his pockets?" I asked. "No, I don't think so, we waited for you," she replied, looking sheepish.

I asked John to empty his pockets, in hopes of finding a "clue".

Empty. Except for the key ring, nothing.

Until, under his faded blue sweatshirt, in the breast pocket of his flannel shirt was what appeared to be a business card!

It turned out to be a "Meal Ticket" bearing the name of a City Shelter! It was stamped with the current date. "Is this where you are staying?" I asked excitedly. John nodded vigorously, pointing to the card in my hand.

The shelter staff informed me that John had disappeared from the shelter three days ago. He had been with them for approximately four months. They had no prior history on John—he had appeared on their doorstep unable to tell them anything about himself. They too wondered about the key ring.

We learned that John as on medication for a seizure disorder and had not had his medication since his disappearance. John was also mentally challenged. We surmised that John had wondered off from the shelter and gotten himself lost. Somehow, he had known to come to a hospital for help. John grinned happily when informed that the shelter van would be picking him up.

We were left to ponder, where did John come from? Where did he belong? What door do those keys open in another time, another life? No one knows John's story, he is unable to tell it.

— Grace Sotirakis, LMSW, graduated from New York University with a masters in social work. She is a medical social worker who provides crisis intervention in a trauma level I emergency department in Brooklyn, NY, and is a social work consultant for a dialysis center. Her expertise in mental health includes providing therapy to children who have been victimized by abuse or neglect.

Concern that writing skills are essential for students to master, prompted Moravian College Professor Dana S. Dunn to release a new and revised second edition of his book, A Short Guide to Writing About Psychology, featuring up-to-date writing techniques and the latest APA-style guidelines. This brief guide that helps students to learn the skills necessary for writing in psychology, are applicable to writing in many disciplines.

Dunn asserts in his book “to write well, you must write often.” Tips in the guide lead students through the writing process step by step. In addition, it presents thorough discussions about how to research psychological literature in the library and on the Internet and how to present those findings in written and oral formats. Special attention is given to the interpretation and report of the results of statistical tests, as well as the preparation of data displays in tables and figures. The guide introduces students to all elements of professional writing in APA style, and offers practical tips for general types of writing that students encounter in the social sciences. Dunn observes that writing is a matter of planning and managing time. “All of us know it, some of us do it, while others continue to struggle.” Tips in the guide are focused on research-based studies, and not creative writing, and prompts the writer to be concise and direct. Dunn also discusses more forms of student writing – including letters, one-minute papers, and blogs, and emphasizes the distinctions between expressive and transactional writing in the guide.

7 Quick tips everyone can do to improve their writing

1. Always create an outline before beginning to write anything, whether it is an article or a memo

2. Begin to write well in advance of your deadline

3. Spread your writing across several sessions rather than engaging in a bout of bingeing at the last minute

4. Revise and edit as you go along from session to session

5. Revise your work from start to finish before beginning a new writing session

6. Ask a peer to read what you write before submitting it

7. Incorporate peer comments into the final version

— Source: Moravian College

Employees seeking treatment for depression who participated in a program that included a telephone outreach intervention had fewer symptoms, worked more hours and had greater job retention than participants receiving usual care, according to a study in the recent issue of the Journal of the American Medical Association. Depression has enormous societal burdens, with annual U.S. economic costs of tens of billions of dollars due largely to productivity losses. Comparative cost-of-illness studies show that depression is among the most costly of all health problems to employers, according to background information in the article. Despite evidence that there are effective treatments, many depressed workers are untreated or inadequately treated. Employer-purchasers (those who purchase corporate health benefits) often do not invest in enhanced depression screening-treatment programs because of the uncertainty of the return-on-investment of such programs.

Philip S. Wang, MD, DrPH, of the National Institute of Mental Health, Rockville, Md., and colleagues examined the impact of a depression outreach-treatment program on the outcomes of depression symptom relief, job retention, sickness absence, and increased work productivity. The randomized controlled trial included 604 employees covered by a managed behavioral health plan who were identified in a 2-stage screening process as having significant depression. The telephonic outreach and care management program encouraged workers (n = 304) to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality continuity, and attempted to improve treatment by giving recommendations to clinicians. Participants reluctant to enter treatment were offered a structured telephone cognitive behavioral psychotherapy. Three hundred participants received usual care.

The researchers found that measurements of depression severity were significantly lower in the intervention than in the usual care group by six months and at 12 months, and that patients in the intervention group were more likely to experience recovery (26.2% vs. 17.7%). Scores on the hours worked measure were significantly higher in the intervention than usual care group at six and 12 months. The data indicated that workers in the intervention group worked an average of two more hours per week than workers in the usual care group, which is equivalent to an annualized effect of more than two weeks of work. This overall effect was due to a higher rate of job retention (92.6% vs. 88.0%) and significantly more hours worked among employed respondents.

“The results suggest that enhanced depression care of workers has benefits not only on clinical outcomes but also on workplace outcomes,” the authors write. “The financial value of the latter to employers in terms of recovered hiring, training, and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers.”

— Source: American Medical Association

By Aileen McCabe-Maucher, RN, MSW, LCSW

Mrs. B lived on the 12th floor of a high-rise housing complex for low-income senior citizens. I hastily read the consult sheet on my elevator ride up to her apartment. “Social worker needs to evaluate for home safety and ability to live alone” the doctor had scribbled in authoritative handwriting. I took a deep breath, wishing that I had more time to investigate the case beforehand.

I stepped off the elevator and navigated the narrow dimly lit hallways, wondering how someone in a walker or wheelchair could possibly pass through this corridor. Miraculously, I located Mrs. B’s apartment despite the fact two of the numbers were missing from her door. Ten years of fieldwork have transformed me into a bloodhound. My ability to locate houses that are off the map astounds my friends and family who know that I get lost in the local mall. Most times I swear I am led to a patient’s home by sheer force of divine intervention.

I knocked loudly on the rickety door which was cracked and sounded as if would splint underneath the force of my fist. I waited patiently before instituting another series of thunderous knocks. Most of my clients are elderly and it is not unusual to wait 10 minutes for someone to answer the door.

“Come in, child.” A soft voice beckoned me from inside as I turned the unlocked doorknob and gradually opened the door.

I was greeted by a smiling 88-year-old African American woman who sat perched on the edge of a ripped couch. Her eyes are warm and inviting “Praise the Lord! I have been waiting for you child. I am so hungry! You can just set the fixin’s on the table here. I can open the milk and take that lid off for myself. I know you need to get going to deliver some more lunches”

Once again, I was mistaken for the meals on wheels volunteer. “Hi, Mrs. B, My name is Aileen and I am the visiting social worker. Your doctor sent me here to see how you are doing since you were released from the hospital.”

“I see. Well, have a seat, honey. You wanna take my blood pressure?” Ms. B boomed as generously offered me her left arm anticipating that I would slap a blood pressure cuff on it.

I gently touched her thin, withered arm and leaned in closer to her ear. “Mrs. B, the nurse will check your blood pressure when she visits later this afternoon. I am the social worker and I am here to chat with you and see how you are managing living alone, seeing as you just got out the hospital. I want to know if there is anything you need help with, maybe in the way of meals, keeping house, taking care of yourself. You mentioned you were hungry. Are you signed up for meals on wheels and waiting on the your lunch delivery?”

“Yessum. I have been waiting since Friday! I am so hungry I could darn near eat the cushion on this couch. But I am blessed to be here with a roof over my head,” Mrs. B said wearily as she patted her stomach.

It’s two o’clock on Monday afternoon, and, like many elderly recipients of the city’s meals on wheels program, Mrs. B had not eaten since midday Friday. Because the meal delivery program does not operate on Saturdays and Sundays, the city’s most vulnerable residents are left to fend for themselves on the weekend. For individuals without friends or family this means going without food for two days.

“Would you like an apple cereal bar?” I offered her a misshapen but intact snack I fished out of the bottom of my purse. Typically I kept my purse well stocked for occasions such as this. However, it was Monday and the third time I dug in my purse for food. I was dismayed to learn this was last item. I made a mental note to stop by the convenience store to pick up a box of soft granola bars prior to my next home visit.

Mrs. B graciously outstretched her and accepted the cereal bar, which had lint and ink spots of the wrapper, remnants from my disheveled pocketbook “Oh thank you honey. I am truly blessed to receive this! I will save it for next weekend. I just know that meal lady is going to be coming soon and I need to keep food handy for when it gets really bad.”

My heart sank and my body buzzed with outrage. Why do people have to suffer like this? As I glanced around I noticed a blood glucose monitor haphazardly placed on the floor by Mrs. B’s feet. For a woman with diabetes, not eating a proper diet could mean the difference between having two, one or no legs. “Mrs. B, with your permission I can arrange for you to have plenty of food for this weekend, so if you’re hungry please feel free to eat the bar now.” I tried to make my tone sound even.

Our conversation was interrupted by a loud series of knocks before the door flew open. I looked up to find a scrawny elderly lady in a stained housecoat standing in the doorway. Her eyes were wild, although somewhat hidden beneath oversized glasses that were held together by duct tape. “Hey Mrs. B, did you get lunch yet?” The lady in the housecoat bellowed, holding on to the wall for support.

“No, Mary, I did not. The meal’s lady is late again, but don’t worry she’ll be here. I have company dear, come back later, hear. ” Mrs. B gestured in my direction.

“Are you a nurse dear?” Mary ignored Mrs. B. and lumbered toward me with an unsteady gait. “My arthritis hurts so bad today. I ran out of those pills and I need some new ones.”

Before I had a chance to respond, a well-dressed woman with a corporate ID badge sauntered in the room. Her arms were laden with hot food trays “Lunch is here!” she beamed, clearly enjoying her volunteer experience.

“Thank the Lord!” Ms. B clapped her hands together and looked upward. Mary exited the room as quickly as possible so she could be sure and be at her place when her meal was delivered.

I offered to help Mrs. B unwrap her lunch, but she was famished and began digging into her rubbery Salisbury steak without entirely removing the foil wrap. She gulped down her meal is a feral, unabashed manner.

“Mrs. B, would you mind if I turned a light on while you are eating.” Although it was a bright and sunny days outside, Mrs. B’s tiny efficiency apartment had one tiny window that cast bleak shadow on the musty room.

“That’s not a good idea child,” Mrs. B said in between bites.

I was concerned that Mrs. B’s electricity had been shut off and needed to investigate this matter further.

“Mrs. B what will happen if I try to turn on the light?” I gestured toward the switch.

“Go ahead, see for yourself.” Mrs. B shrugged, placing her fork in the starchy mashed potatoes.

As I flipped the switch I was happy to see the room fill with light. However, I was appalled to see the numerous roaches that literally came out of the woodwork when I turned the lamp on. I looked down at my foot. Moments earlier I had become aware of a sensation below my ankle that I had mistakenly attributed to sitting in one place for so long. I watched in horror as two huge roaches scampered across the top of my foot looking for refuge. I vowed to get Mrs. B into a better living situation. I also vowed never to wear sandals on a home visit again. This was far from the first time I had seen cockroaches but this was one of the worst infestations I had seen in a while. I tried not to look repulsed but despite her near blindness Mrs. B was one perceptive lady. “They are God’s creatures just like us child. Great and small. They have to eat, too.” Mrs. B placed a piece of her meat on the floor ostensibly for the cockroaches.

Mrs. B and I spent the next hour talking. Mrs. B told me about the 60 years she spend working as a seamstress and housekeeper. As tears filled my eyes, she told me of her three children and beloved husband that died in a house fire 50 years ago. With conviction, she described how she survived the heartache by opening up her new home to foster children and extended family. Mrs. B is the sole survivor of a family rocked by tragedy. One by one her few remaining relatives died. Mrs. B was literally alone in the world; housebound with no identifiable next of kin “I know it will be my turn soon. I am so blessed to get to be on this Earth for so long, I can’t complain. It has been a gift. But I can’t wait to go home again to the Lord, child. To my babies.” Her eyes glistened with anticipation.

As I listed to Mrs. B’s life story in awe I gently steered the topic of the conservation to the present and Mrs. B’s plans for the future. Ultimately, Mrs. B chose to go spend her remaining years in a nursing home. I heard from a friend of mine that works at the nursing home in which she resides, Mrs. B always saves a portion of her meal and gives it the therapy dogs that visits the nursing home on a weekly basis.

— Aileen McCabe-Maucher, RN, MSW, LCSW, works for Children and Families First in Wilmington, DE, and is also an adjunct faculty member at Delaware Technical and Community College. In addition, she maintains a small private practice.

A study of families in the Netherlands indicates that children raised by lesbian couples “do not differ in well being or child adjustment compared with their counterparts in heterosexual-parent families.” The study was conducted by Henny Bos, Frank van Balen, and Dymphna van den Boom of the University of Amsterdam and published in the American Journal of Orthopsychiatry.

“The findings in the Dutch study are identical to those in a very large number of U.S. studies,” says Robert-Jay Green, PhD, director of Rockway Institute, a national center for research and public policy on lesbian, gay, bisexual, and transgender issues. “Children do well in loving families, regardless of whether there are two moms or a mom and a dad involved. The study involved 100 heterosexual couples and 100 lesbian couples with children ages 4 to 8 who were raised by the couple since birth. The number of boys and girls in each of the comparison groups was almost identical. Child adjustment and parental characteristics were measured by questionnaires, family observations by researchers, and diaries kept by the parents regarding the amounts of time they spent in childrearing, household work, or paid work outside the home.

Among the most interesting findings, lesbian biological mothers were significantly more satisfied with their partners as a coparent than were heterosexual mothers. The partners of lesbian biological mothers “are more committed as parents than are heterosexual fathers, that is, they display a higher level of satisfaction with their partner as coparent and spend more time on child care and less on employment.” Lesbian couples were significantly higher on strength of desire to have children than were heterosexual couples. There were significant differences in the division of family tasks, with both of the lesbian partners spending more time on household work and childcare, and less time at work outside the home, than the heterosexual fathers. The differences between lesbian mothers and heterosexual fathers seemed to reflect known differences between women and men as parents rather than reflecting parents’ sexual orientations.

“These results on lesbian parents pique our curiosity for more data on gay male parents,” says Green. “Will gay fathers’ parenting styles turn out to be more like those of heterosexual fathers, heterosexual mothers, or some combination? One of Rockway’s planned research projects will shed light on that question in the future.” From a public policy perspective, the most important aspect of this research is that it found no significant differences in child adjustment between family types. In recent years, consistent research findings like these have led the American Academy of Pediatrics, American Psychiatric Association, and American Psychological Association to issue official policy statements supporting equal treatment of families headed by lesbian and gay parents.

— Source: Alliant International University

A researcher with the Monroe Carell Jr. Children’s Hospital at Vanderbilt has been named the principal investigator for the largest-ever data review to examine the potential for serious cardiac side effects in children who take prescription medications for attention-deficit/hyperactivity disorder (ADHD). William O. Cooper, MD, MPH, associate professor of Pediatrics and director of Vanderbilt’s Child and Adolescent Health Research Unit, along with investigators at four other research sites, received a contract from the Agency for Healthcare Research and Quality (AHRQ) to conduct the massive review of records. Data for the study has been drawn from the insurance records of 10 million U.S. children. Among this group, nearly 300,000 children have been identified as having taken medications used to treat ADHD.

Cooper will lead the medical record review to see if rare cases of sudden cardiac death, heart attack, and stroke are somehow related to the medications. ADHD medications are known to increase heart rate and blood pressure. But it is not known whether these side effects directly, or even indirectly, might cause children to suffer heart attack or stroke. “The FDA had received a series of reports about these events occurring in children with exposure to ADHD medications. However, the events are relatively rare,” Cooper says. “Because of the ability to identify large populations of persons through large health claim datasets we anticipate being able to pull together a large enough sample from several locations across the country to identify whether a real risk exists,” Cooper says. “One of the strengths of this work is the ability to build upon the important work in drug safety studies conducted by my collaborators, Wayne Ray, PhD, and Marie Griffin, MD, MPH, here at Vanderbilt over the past 30 years,” Cooper adds.

As principal investigator, Cooper has been contracted by the AHRQ to draw on his own review of TennCare records, and will combine that data with data from three other sites to be analyzed at Vanderbilt. Investigators from each of the sites—which include Kaiser Permanente of California, the HMO Research Network and i3 Drug Safety, as well as scientists at AHRQ and the Food and Drug Administration (FDA)—will be collaborating on the research. The study also has an adult component that is being coordinated elsewhere to review similar adult records for the same time period, from1998 to 2005. The analysis will cover all drugs currently marketed for treating ADHD, including the most popular: Concerta, Adderall, and Strattera. These three medications alone are ranked among the top five of all drugs prescribed for children under the age of 17. A recent AHRQ analysis found $1.3 billion was spent on these three drugs in 2004.

In May 2006, based on a review of anecdotal reports of sudden death, stroke and heart attack among patients taking usual doses of ADHD medications, the FDA asked drug manufacturers to revise product labeling to reflect concerns about possible adverse events. Drug manufacturers have created Patient Medication Guides for individual products to help patients understand associated risks. This massive data review will determine whether further labeling changes or some other safety action is needed. The analysis will take two years to complete.

— Source: Vanderbilt University Medical Center

In an 18-year-study on attention-deficit/hyperactivity disorder (ADHD), Mayo Clinic researchers found that treatment with prescription stimulants is associated with improved long-term academic success of children with ADHD. The Mayo Clinic results are the first population-based data to show stimulant drug therapy helps improve long-term school outcomes. A related Mayo Clinic study reveals that compared with children without ADHD, children with ADHD are at risk for poor long-term school outcomes such as low achievement in reading, absenteeism, repeating a grade, and dropping out of school. Both studies appear in a recent edition of the Journal of Development & Behavioral Pediatrics.

“In this study, treatment with stimulant medication during childhood was associated with more favorable long-term school outcomes,” explains William Barbaresi, MD, Mayo Clinic pediatrician and lead author of the reports. The two Mayo Clinic studies are the first population-based, long-term studies to investigate links between ADHD, school performance and factors that modify long-term school performance of children with ADHD. Researchers followed the children from the time they were born for, on average, 18 years. Of the more than 5,000 children evaluated, 370 (277 boys and 93 girls) were identified as having ADHD. Researchers matched them by age and gender to 740 children who did not meet the research criteria for having ADHD. In addition to medical stimulants such as methylphenidate (Ritalin), the study examined the effects on school outcomes of maternal age, socioeconomic background, and special education services the students received.

The children treated with stimulants typically began taking medication in elementary school and received it for nearly three years—on average, for 30.4 months. Results indicate: girls and boys with untreated ADHD were equally vulnerable to poor school outcomes—and girls may be at risk for being under-identified as having ADHD, and therefore undertreated; by age 13, on average, stimulant dose was modestly correlated with improved reading achievement scores; both treatment with stimulants and longer duration of medication were associated with decreased absenteeism; children with ADHD who were treated with stimulants were 1.8 times less likely to be retained a grade than children with ADHD who were not treated.

Barbaresi believes that both studies provide the first solid evidence of the long-term negative academic performance associated with untreated ADHD—as well as evidence for the best way to manage this problem. Barbaresi says, “The finding that treatment with stimulant medications is associated with long-term improvement in school outcomes is significant. Previously, there was evidence that treatment with stimulant medications improved short-term academic performance, but there was no good evidence that long-term outcomes are better with stimulant treatment. Our data can guide clinicians in their efforts to help children with ADHD succeed in school.”

— Source: Mayo Clinic

Children under treatment for cancer are generally emotionally well-adjusted and no more depressed or anxious than other children their age, according to researchers at St. Jude Children’s Research Hospital. In studies of depression, anxiety, posttraumatic stress, and quality of life, children with cancer do as well as, and often better than, their healthy peers. “We see them as a flourishing population that has adapted to the stress of having cancer and undergoing treatment,” says Sean Phipps, PhD, a member of the St. Jude Division of Behavioral Medicine. “They become quite resilient to the long- and short-term emotional and physical effects of their disease and the treatments.”

The unexpected finding that children with cancer are emotionally resilient is important because of the dramatic improvement in survival rates of pediatric cancers. “There has been a shift in research toward the concerns of long-term survivors of pediatric cancers,” Phipps says. “The ability of these children to cope with the after-effects of cancer is the major issue now. What we are learning from this population might help us learn how to improve the quality of life of children who are not doing so well.” Phipps is the author of an article on adaptive styles in children with cancer that appears in the online issue of Journal of Pediatric Psychology.

The low level of depression among children with cancer does not reflect a state of “illusory mental health,” Phipps says. That is, these children are not simply clinging to an illusion of mental health by denying distress. Rather, many of them simply have a reduced awareness of emotional distress, and they think of themselves as being well-adjusted and content, a response called a “repressive adaptive style.” Children who have a repressive adaptive style have a personality characterized by a positive self-image and avoidance of threat, Phipps says. Such children tend to think of themselves as well-adjusted, self-controlled, and content. Only a small percentage of these children experience emotional difficulties that become serious enough to be called pathologic, he says.

“The finding that children with cancer are flourishing comes largely from self-report studies in which children discussed their own responses to stresses in their lives,” Phipps says. “This is good news that many researchers in the field have been reluctant to embrace. There is a tendency instead to question whether this conclusion is mistaken; whether we’ve missed something in our studies or have not done the right studies. But the finding has held up over time, and we have not yet found a self-report test that documents in children a high level of difficulty adjusting to their disease.”

"Research psychologists have historically focused on searching for problems that need fixing, rather than on a person’s strengths," Phipps says. "However, our findings suggest that gaining a better understanding of how children are able to remain so well adjusted in the face of difficult life challenges may provide a more fruitful approach to our research."

— Source: St. Jude Children's Research Hospital

While commonly perceived as a cry for attention from troubled teenage girls self-injury is a dangerous and potentially life-threatening behavior that also occurs in adults of both genders. “Stereotypically people think that self-injury happens only among teenagers and young women, but it also happens with older, middle-aged females and males,” says Harrell Woodson, PhD, director of the Menninger Hope Program, which treats adults with mental illness. The program is participating in a clinic-wide initiative to learn more about self-injury and to develop new protocols to treat it, since it is a frequent health issue among Menninger patients. Older patients who injure themselves—commonly by cutting or burning the skin, or banging their heads repeatedly against the wall—are more difficult to treat, Woodson says. They may have been injuring themselves for such a long time that the behavior has become deeply ingrained.

Self-injury can be a sign of a psychiatric disorder, and is common among persons suffering from severe borderline personality disorder, depression or psychosis. While the number of adults who purposely injure themselves is unknown, the behavior may be underreported because many persons who self-injure hide it from others. Left untreated, self-injury and the mental illness that often accompanies it can become dangerous. While most persons who self-injure are not attempting suicide, they may accidentally kill themselves if their behavior goes too far. “Self-injurious behavior can cause irreparable physical damage and can even lead to death, from cutting too deeply, getting an infection or going into shock,” Woodson says.

Because self-injury can be such a deeply ingrained behavior in older adults, helping patients find alternative coping mechanisms can be difficult. For patients, self-injurious behavior is often one of the few areas in their lives in which they feel a sense of control. Confronting them about the negative aspects of the behavior will not necessarily lead to behavior change. Instead, mental health professionals work together with patients to determine how motivated they are to stop their self-injurious behavior. The desire for behavior change needs to come from the patient rather than as a demand from the mental health professional or family members, Woodson says. Motivational interviewing techniques put the majority of the responsibility for behavior change in the hands of the patient.

“With motivational interviewing, you capitalize on the patient’s ambivalence—in terms of the pros and cons of continuing that behavior, in a non-confrontational way,” Woodson continues. “Traditionally, admonishing people about the consequences of self-injurious behavior doesn’t work very well.” The treatment team on Hope works with patients to discover what triggers a person to self-injure and to develop alternative coping strategies meaningful to that person. One alternative some mental health professionals suggest is to have patients place a rubber band around their arms. Snapping the rubber band creates some pain but no lasting injury. Treatment may also include medication, especially when self-injurious behavior is tied to psychosis, and group therapy. Patients in group therapy discuss what they could do differently in response to particular stressors, situations, thoughts and feelings rather than harming themselves. Groups are an effective form of treatment for self-injury, Woodson says, because patients learn new insights and adaptive behaviors from their peers as well as receiving support and encouragement.

— Source: Menninger Clinic

A nationwide survey of the religious beliefs and practices of American physicians has found that the least religious of all medical specialties is psychiatry. Among psychiatrists who have a religion, more than twice as many are Jewish and far fewer are Protestant or Catholic, the two most common religions among physicians overall. The study, recently published in Psychiatric Services, also found that religious physicians, especially Protestants, are less likely to refer patients to psychiatrists, and more likely to send them to members of the clergy or to a religious counselor. "Something about psychiatry, perhaps its historical ties to psychoanalysis and the antireligious views of the early analysts such as Sigmund Freud, seems to dissuade religious medical students from choosing to specialize in this field," says study author Farr Curlin, MD, assistant professor of medicine at the University of Chicago. "It also seems to discourage religious physicians from referring their patients to psychiatrists."

"Previous surveys have documented the unusual religious profile of psychiatry, but this is the first study to suggest that that profile leads many physicians to look away from psychiatrists for help in responding to patients’ psychological and spiritual suffering,” he says. “Because psychiatrists take care of patients struggling with emotional, personal, and relational problems, the gap between the religiousness of the average psychiatrist and her average patient may make it difficult for them to connect on a human level."

In 2003, to learn about the contribution of religious factors on physicians' clinical practices, Curlin and colleagues surveyed 1,820 practicing physicians from all specialties, including an augmented number of psychiatrists; 1,144 (63%) physicians responded, including 100 psychiatrists. The survey contained questions about medical specialties, religion, and measures of what the researchers called intrinsic religiosity—the extent to which individuals embrace their religion as the "master motive that guides and gives meaning to their life." Although 61% of all American physicians were either Protestant (39%) or Catholic (22%), only 37% of psychiatrists were Protestant (27%) or Catholic (10%). Twenty-nine percent were Jewish, compared with 13% of all physicians. Seventeen percent of psychiatrists listed their religion as "none," compared with only 10% of all doctors.

Curlin's survey also included this brief vignette, designed to present "ambiguous symptoms of psychological distress" as way measure the willingness of physicians to refer patients to psychiatrists. Overall, 56% of physicians indicated they would refer such a patient to a psychiatrist or psychologist, 25% to a clergy member or other religious counselor, 7% to a healthcare chaplain, and 12% to someone else. Although Protestant physicians were only half as likely to send the patient to a psychiatrist, Jewish physicians were more likely to do so. Least likely were highly religious Protestants who attended church at least twice a month and looked to God for guidance "a great deal or quite a lot."

"Patients probably seek out, to some extent, physicians who share their views on life’s big questions," Curlin says. That may be especially true in psychiatry, where communication is so essential. The mismatch in religious beliefs between psychiatrists and patients may make it difficult for patients suffering from emotional or personal problems to find physicians who share their fundamental belief systems.

— Source: University of Chicago Medical Center

Physicians might want to be extra careful about how they treat HIV-infected patients—not just in the clinical sense but in the way they behave toward them. Even the perception that physicians are stigmatizing patients for carrying the virus that causes AIDS can discourage these individuals from seeking proper medical care, according to a new University of California, Los Angeles (UCLA) study.

The study, published in a recent issue of the peer-reviewed journal AIDS Patient Care and STDs, found that up to one fourth of patients surveyed in the Los Angeles area reported feeling stigmatized by their healthcare providers. This perception was also linked to low access to care among these patients, a large proportion of whom are low-income and minorities. “Whether or not it is actual stigmatization is hard to measure, because it’s coming from the patients that we interviewed,” says UCLA researcher Janni J. Kinsler, the study’s project director and lead researcher. “The point is that these people feel that way, and that’s bad enough, because they’re less likely to seek the care they need.” The study results were based on surveys of 223 HIV-positive individuals in Los Angeles County, with initial baseline interviews taking place between May 2004 and June 2005 and follow-up interviews conducted six months later, from November 2004 to December 2005.

There are two types of stigma: external, or “public,” stigma and personal, or “perceived,” stigma. The latter refers to individuals’ anticipated fears of societal attitudes or discrimination because their HIV infection. Researchers questioned 223 patients during the baseline interviews and 171 during the follow-up. The researchers found that at baseline 26% of the patients reported at least one of the four types of perceived stigma from a healthcare provider, and 19% reported the same at follow-up. Also, 58% claimed low access to care on at least one of the six relevant questions at baseline, as did 57% at follow-up.

“Most importantly, we found that those who perceived stigma from a healthcare provider had more than twice the odds of reporting low access to care, even after examining the effect prospectively and adjusting for a host of sociodemographic and clinical characteristics,” the researchers say. Researchers note the significance that perceived stigma “could greatly affect [patients’] use of needed medical services, including antiretroviral therapy.” Because of this, patients may seek medical care only when their illness has progressed to a more severe stage, leading to more intensive medical interventions, hospitalization, and earlier death.

— Source: University of California, Los Angeles, Health Sciences

The National Institutes of Health has awarded $22.5 million to a team of scientists centered at the Semel Institute for Neuroscience and Human Behavior at University of California, Los Angeles (UCLA) to fund the Consortium for Neuropsychiatric Phenomics (CNP), an interdisciplinary, campuswide effort to understand the biology underlying a variety of mental disorders.

Phenomics is the study of an organism’s full complement of phenotypes, says Robert Bilder, UCLA professor of psychiatry and director of the new consortium. Understanding an organism’s phenotype is the next logical step following the recent decoding the human genome. That decoding effort, which discerned the DNA sequences that form the basic instructions for biological processes, was designed to enable the identification of genetic variations responsible for the major diseases that plague humankind. Phenomics takes a more “holistic viewpoint,” Bilder says. “To understand how these genetic variations are associated with disease now requires the decoding of the human phenome, the sum of the physical and behavioral manifestations of those genetic variations and how they interact with the environment.

Currently, psychiatrists do not possess the types of laboratory tests or biological models that can be useful in studying these disorders, Bilder says. “The diagnostic systems we have in place are widely acknowledged to be flawed, because the phenotypes we have are not based on research but are descriptive,” he says. “That is, they are based on symptoms we usually learned about, ironically, from asking patients who have disorders that make communication difficult.

“We so far lack markers to identify more fundamental deficits,” he adds. “We need to drill down and get closer to the specific level where a gene might be responsible for the process.” In a departure from science-as-usual, the consortium will aim to discover the underpinnings of basic, healthy functioning systems, such as memory and impulse control, rather than concentrating on the genetic anomalies that may be associated with the neuropsychiatric disorders themselves. By focusing on these healthy brain systems, the researchers hope to accelerate the discovery of genes that are relevant to mental disorders and to find new treatments.

“Our team is thrilled to have this opportunity to forge a unique path in neuropsychiatry research,” Bilder says. “Many scientists and clinicians already acknowledge major limitations in the current system for diagnosing and treating patients. We believe the CNP strategy strongly complements existing approaches and offers new hope for discovery.”

— Source: University of California, Los Angeles, Health Sciences

Counseling and support for people caring for a spouse with Alzheimer’s disease helps to preserve their health, according to a new study led by Mary S. Mittelman, DrPH, research professor in the department of psychiatry at New York University School of Medicine. The study is published in a recent issue of the American Journal of Geriatric Psychiatry.

Spouses of people with Alzheimer’s disease usually are older adults. While people who take on the caregiving role tend to be healthier than those who do not, caring for someone with Alzheimer’s disease is difficult in the best of circumstances, and can take a toll on a person’s health. Caregivers in the study who received an intervention developed at NYU Medical Center by Mittelman and her colleagues reported less of a decline in their physical health than those receiving usual care. “Preserving the health of spouse caregivers through counseling and support also benefits the person with Alzheimer’s disease, as caregivers who are in poor health are more likely to have difficulty providing good care,” says Mittelman.

The study is the latest result from ongoing research conducted over the past 20 years by Mittelman. It is the longest research study ever devoted to testing an intervention to improve the well-being of Alzheimer’s caregivers. The study, which began in 1987, involved 406 spouse caregivers of people with Alzheimer’s disease who were divided equally into two groups. The first group received enhanced counseling and support, including six sessions of individual and family counseling, support groups, and telephone counseling for the caregiver and family members as needed. The second group had usual care, which meant that they received information and help upon request, but didn’t participate in formal counseling sessions.

Previous results from this study have shown that caregiver spouses who received the enhanced counseling and support delayed placing their ailing spouse in a nursing home by 1.5 years compared with caregiver spouses who received usual care. Mittelman and her colleagues also found that counseling and support substantially eases the depression of spouse caregivers. The new results indicate that this intervention can also help maintain the physical health of caregivers.

In the new study, the researchers gauged caregivers’ self-reported health, an important predictor of physical illness, with questions that have been used widely in national surveys by the Centers for Disease Control and Prevention, and internationally by the World Health Organization. The intervention had a beneficial effect on self-rated health, which began within four months of enrollment, and lasted more than a year, according to the study. “Individualized counseling programs that improve social support for caregivers can have many indirect benefits, including sustaining their physical health,” says Mittelman.

— Source: New York University Medical Center

In the first randomized, controlled trial for adolescent bulimia nervosa to be completed in the United States, researchers show that mobilizing parents to help an adolescent overcome the disorder can double the percentage of teens who were able to abstain from binge eating and purging after six months. In a recent issue of Archives of General Psychiatry, a team based at the University of Chicago Medical Center show that almost 40% of participants in family-based treatment had stopped binging and purging compared to only 18% of those who received supportive psychotherapy, the standard therapy. Six months after treatment, almost 30% of participants who received family-based treatment were still abstinent compared with only 10% of participants who received supportive psychotherapy, which focuses on issues underlying the eating disorder.

"Parents are in a unique position to help their adolescents," says study author Daniel le Grange, PhD, associate professor of psychiatry and director of the Eating Disorders Program at the University of Chicago, "yet treatment typically excludes them from the process. Now we have the evidence that we need to bring them back in." The trial, conducted at the University of Chicago, involved 80 adolescents, aged 12 to 19, with a diagnosis of bulimia nervosa (typically characterized by binge eating and purging) or a strict definition of partial bulimia nervosa. Forty-one patients were randomly assigned to family-based treatment, and 39 patients were randomly assigned to supportive psychotherapy. Patients from each group made 20 visits to the clinic over a six-month period.

In family-based treatment, parents and at times even siblings attend clinic sessions with the patient. Parents play an active follow-up role at home, encouraging their adolescents to eat as normally as possible, then monitoring them during and after meals to make sure they eat and are not tempted to purge. "For years parents have been left out of the treatment process," Le Grange says. They often feel guilty about intervening. "But what parent would step aside and play a minimal role in treatment if their child was diagnosed with cancer? Nor should they if a child has an eating disorder. Eating disorders pose serious health hazards."

Although the family-based approach produced superior results, the research team is uncertain whether it was the family involvement or the focus on eating behavior found in family-based treatment that was responsible for the improved outcomes. "We still have work to do on understanding and treating eating disorders," Le Grange says. "While we're happy for how well this approach has done, obviously abstinence rates between 30% to 40% leave considerable room for improvement."

— Source: University of Chicago Medical Center

A University of Iowa (UI) professor is making a case for a new eating disorder she calls purging disorder. The disorder is similar to bulimia nervosa in that both syndromes involve eating, then trying to compensate for the calories. What sets the disorders apart is the amount of food consumed and the way people compensate for what they eat. Women with purging disorder eat normal or even small amounts of food and then purge, often by vomiting. Women with bulimia have large, out-of-control binge eating episodes followed by purging, fasting or excessive exercise. "Purging disorder is new in the sense that it has not been officially recognized as a unique condition in the classification of eating disorders," says Pamela Keel, associate professor of psychology in the UI College of Liberal Arts and Sciences, "But it's not a new problem. Women were struggling with purging disorder long before we began studying it."

In a paper published recently in the Archives of General Psychiatry, Keel shares the results of a study indicating that purging disorder is a significant problem in women that is distinct from bulimia. Keel recruited participants for three groups: women without eating disorders, women who purge to compensate for binge episodes, and women with purging disorder who purge to control their weight or shape but do not have binge episodes. Participants came from the Boston and Iowa City/Cedar Rapids areas and were within a healthy weight range. The women completed self-report questionnaires and clinical interviews. They also had blood drawn before and after consuming a liquid test meal and reported their feelings throughout the meal, including feelings of fullness, hunger, sadness, or tension.

Keel discovered that women with purging disorder tend to share some characteristics with bulimics: Both experience greater depression, anxiety, dieting, and body image disturbance than women without eating disorders. But the study also provided evidence that purging disorder is a distinct illness. Women with purging disorder differed from women with bulimia on a physiological mechanism that influences food intake. Those with purging disorder also reported greater fullness and stomach discomfort after eating compared with women with bulimia and women without eating disorders. Keel says more research on purging disorder is needed to better understand the condition and to support its inclusion in the classification of eating disorders.

"Because we tend to only study formally defined disorders, this creates a gap between the problems people have and what we know about those problems," Keel says. "Identifying this disorder would stimulate research on its causes, treatment and prevention, which could alleviate the distress and impairment women with the illness suffer." Keel is working on a follow-up study which will explore why some women feel the need to purge after eating what most people would regard as a normal or even small amount of food. She hopes this information will provide insight into what types of treatments may be effective for purging disorder.

"Right now there are no evidence-based treatments for purging disorder," Keel says. "It would be a disservice to women with purging disorder to assume that treatments that work for bulimia nervosa will work for purging disorder, given the differences we found between the syndromes. Additional research is crucial for advancing our understanding of purging disorder."

— Source: University of Iowa Health Sciences

Unstable and unpredictable lifestyles are significant factors in determining access to healthcare among low-income people who are HIV-positive, a new UCLA study has found. The study, to be published in the September issue of the Journal of General Internal Medicine, found that when patients with HIV lead chaotic lives—meaning they are disorganized or experience too many unexpected events—that chaos can act as a barrier to regular medical care. The researchers also developed a new scale to gauge the level of chaos in an adult’s life.

The findings suggest a possible new alternative to help ensure that low-income patients get the care they need, says the study’s lead author, Mitchell Wong, MD, PhD, an assistant professor of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “Many people have barriers to care, such as problems with transportation, housing, child care and health insurance. Traditionally, we look to solve these problems with case managers who can help reduce these barriers,” Wong says. “But there’s a whole potential other mechanism which might be happening—that people are just having trouble managing and organizing their lives. I think many of us take for granted the support mechanisms that we have, but many people who are living in poverty don’t have that support network. They don’t have that buffer zone to cope with the unexpected things. Perhaps enhancing stability and organization in people’s lives can also help them get the regular care that they need.”

Some 220 low-income HIV-positive patients participated in the study. Of those, 45% were African American, 40% were Latino, and 20% were women. About one third did not graduate from high school, approximately 75% had a history of homelessness, and half had used drugs in the previous 30 days. In addition, 45% were uninsured and 75% had one or more unmet social-service need. In the six months prior to the study, 83% had seen a physician for HIV care at least twice, 46% missed two or more visits, and one third had gone to a hospital emergency room at least once.

The researchers found that those patients who did not have spouses or partners and those with at least one unmet social-service need, such as transportation or housing, scored highest on the chaos scale. They also found that patients with more chaos in their lives were less likely to have had two or more outpatient HIV care visits and were more likely to have missed two or more visits in the six months prior to enrolling in the study. These patients also had lower mental health status, both when they enrolled in the survey and at follow-up. The researchers, however, did not find an association between life chaos and emergency department visits or physical health status.

— Source: University of California, Los Angeles, Health Sciences

It’s already known that a person’s social environment can affect their health, with those who are socially isolated—that is, lonely—suffering from higher mortality than people who are not. Now, in the first study of its kind, published in a recent issue of Genome Biology, University of California, Los Angeles, (UCLA) researchers have identified a distinct pattern of gene expression in immune cells from people who experience chronically high levels of loneliness. The findings suggest that feelings of social isolation are linked to alterations in the activity of genes that drive inflammation, the first response of the immune system. The study provides a molecular framework for understanding why social factors are linked to an increased risk of heart disease, viral infections and cancer.

Having previously established that lonely people suffer from higher mortality than people who are not, researchers are now trying to determine whether that risk is a result of reduced social resources, such as physical or economic assistance, or from the biological impact of social isolation on the function of the human body. “What this study shows is that the biological impact of social isolation reaches down into some of our most basic internal processes the activity of our genes,” says Steve Cole, an associate professor of medicine in the division of Hematology-Oncology at the David Geffen School of Medicine, and a member of the UCLA Cousins Center for Psychoneuroimmunology.

“We found that changes in immune cell gene expression were specifically linked to the subjective experience of social distance,” says Cole. “The differences we observed were independent of other known risk factors, such as health status, age, weight, and medication use. The changes were even independent of the objective size of a person’s social network.” Genes overexpressed in lonely individuals included many involved in immune system activation and inflammation. But interestingly, several other key gene sets were underexpressed, including those involved in antiviral responses and antibody production. “These findings provide molecular targets for our efforts to block the adverse health effects of social isolation,” says Cole.

“We found that what counts at the level of gene expression is not how many people you know, it’s how many you feel really close to over time.” In the future, he says, the transcriptional fingerprint they’ve identified might become useful as a ‘biomarker’ to monitor interventions designed to reduce the impact of loneliness on health.

— Source: University of California, Los Angeles, Health Sciences

A startling number of high school and college students—both female and male—are being battered, sexually abused or stalked by their dates, according to a Kansas State University (K-State) professor. "Approximately 30% of college students have been in relationships that involve physical aggression. Even more have been in relationships that are emotionally abusive," says Sandra Stith, director of the marriage and family therapy program at K-State and a nationally recognized expert in domestic violence. Likewise, approximately 25% of high school students who are in relationships are subjected to abuse, according to Stith.

Why?

Research points to many complex triggers, says Stith, who also is a pioneer in couples treatment for domestic violence. Stress and the inability to control anger are common ones. Another is the intensity of the relationship. Stith says studies show that the more serious the liaison, the more likely it is to be violent.

Too many students think they don't deserve better treatment, she says. Some think hitting and abusive language are acceptable. "It is never OK to be emotionally abusive or physically violent," Stith says. "We need to send a clear message that abuse in any form is not normal, not acceptable and not OK."

Research clearly indicates that both male and female students are victims of physical and emotional abuse. "We cannot minimize violence against women," she says. "Male violence is more likely to cause serious injury and death." However, just like female victims, male victims often accept blame for the abuse, saying things like "it's my fault because I am not listening to her," Stith says.

She said abuse in young relationships takes other forms: attempting to control the partner's behavior, extreme jealousy, constant belittling and trying to frighten a partner with activities such as driving recklessly.

— Source: Kansas State University

The medication tamoxifen, best known as a treatment for breast cancer, dramatically reduces symptoms of the manic phase of bipolar disorder more quickly than many standard medications for the mental illness, a new study shows. Researchers at the National Institutes of Health's National Institute of Mental Health (NIMH) who conducted the study also explained how: Tamoxifen blocks an enzyme called protein kinase C (PKC) that regulates activities in brain cells. The enzyme is thought to be over-active during the manic phase of bipolar disorder.

By pointing to PKC as a target for new medications, the study raises the possibility of developing faster-acting treatments for the manic phase of the illness. Current medications for the manic phase generally take more than a week to begin working, and not everyone responds to them. Tamoxifen itself might not become a treatment of choice, though, because it also blocks estrogen—the property that makes it useful as a treatment for breast cancer—and because it may cause endometrial cancer if taken over long periods of time. Currently, tamoxifen is approved by the Food and Drug Administration for treatment of some kinds of cancer and infertility. It was used experimentally in this study because it both blocks PKC and is able to enter the brain.

Results of the study were published online in a recent issue of Bipolar Disorders by Husseini K. Manji, MD, Carlos A. Zarate Jr., MD, and colleagues.

"People think of the depressive phase of this brain disorder as the time of risk, but the manic phase has its own dangers," says NIMH Director Thomas R. Insel, MD. "Being able to treat the manic phase more quickly would be a great asset to patients, not just for restoring balance in mood, but also because it could help stop harmful behaviors before they start or get out of control."

The three-week study included eight patients who were given tamoxifen and eight who were given a placebo (a sugar pill); all were adults and all were having a manic episode at the time of the study. Neither the patients nor the researchers knew which of the substances the patients were getting. By the end of the study, 63% of the patients taking tamoxifen had reduced manic symptoms, compared with only 13% of those taking a placebo. Patients taking tamoxifen responded by the fifth day—which corresponds with the amount of time needed to build up enough tamoxifen in the brain to dampen PKC activity.

The researchers decided to test tamoxifen's effects on the manic phase of bipolar disorder because standard medications used to treat this phase, specifically, are known to lower PKC activity—but they do it through a roundabout biochemical route that takes time. Tamoxifen is known instead to block PKC directly. As the researchers suspected would happen, tamoxifen's direct actions on PKC resulted in much faster relief of manic symptoms, compared with some of the standard medications available today.

— Source: National Institutes of Health

How the gene that has been pegged as a major risk factor for schizophrenia and other mood disorders that affect millions of Americans contributes to these diseases remains unclear. However, the results of a new study by Hopkins researchers and their colleagues, appearing in Cell this week, provide a big clue by showing what this gene does in normal adult brains. It turns out that the gene, called DISC1, makes a protein that serves as a sort of musical conductor for newly made nerve cells in the adult brain, guiding them to their proper locations at the appropriate tempo so they can seamlessly integrate into our complex and intertwined nervous system. If the DISC1 protein doesn’t operate properly, the new nerves go hyper. “DISC1 plays a broader role in the development of adult nerves than we anticipated,” says Hongjun Song, PhD, an associate professor at Hopkins’ Institute for Cell Engineering (ICE). “Some previous studies hinted that DISC1 is important for nerve migration and extension, but our study in mice suggests it is critical for more than that and may highlight why DISC1 is associated with multiple psychiatric disorders.”

“Almost every part of the nerve integration process speeds up,” adds fellow author Guo-li Ming, MD, PhD, also an associate professor at ICE. “The new nerves migrate and branch out faster than normal, form connections with neighbors more rapidly, and are even more sensitive to electrical stimulation.” While it may not be obvious why high-speed integration would be detrimental, Song notes that because of the complexity of the brain, timing is critical to ensure that new nerves are prepared to plug into the neural network. Ming, Song, and their collaborators at the National Institutes of Health and UC Davis tracked the abnormal movements of the hyperactive nerve cells by injecting a specially designed virus into a part of a mouse brain known as the hippocampus—a region important for learning and memory and therefore quite relevant to psychiatric disorders. The virus would only infect newly born cells and would both knock down the expression of the DISC1 gene and make the nerves glow under a microscope.

Combined with other recent Hopkins research that successfully engineered mouse models that have abnormal DISC1 and can effectively reproduce schizophrenia symptoms such as anxiety, hyperactivity, apathy, and altered senses, these current findings teasing out the normal role of this protein may help unravel the causes for this complex disease, Song and Ming add that their studies in the hippocampus—one of the few places where new nerves are made in the adult brain—might answer why symptoms typically first appear in adults despite the genetic basis of many psychiatric illnesses. They plan on continuing their mouse work to try and find those answers.

— Source: Johns Hopkins Medical Institutions

Mental disorders rank among the top ten illnesses causing disability—more than 37% worldwide—with depression being the leading cause of disability among people aged 15 and older, according to the "Global Burden of Disease and Risk Factors" published in 2006. Yet, the world's mental health care needs are largely going unmet, especially in less developed nations and in high-income countries, according to results from a new survey of 17 countries conducted as part of the World Health Organization's (WHO) World Mental Health Survey Initiative. The results of the initiative, partially funded by the National Institutes of Health's National Institute of Mental Health (NIMH), were published in The Lancet. "Good treatments are available for many mental disorders. Yet, the world continues to struggle with the very real challenge of providing these services to the people who most need them," says NIMH Director Thomas R. Insel. "The WHO survey unmistakably reinforces the urgency that we must do better."

Philip S. Wang, MD, DrPH, currently director of the NIMH Division of Services and Intervention Research, and colleagues analyzed data from face-to-face interviews on mental health service use with 84,848 adults across all economic spectrums in countries around the world. Respondents were asked about anxiety, posttraumatic stress, mood, and substance abuse disorders. They were also asked if they received any services in the past year for mental disorders, and if so, what types of services they had used, such as general medical professional, mental health professional, religious counselors, or traditional healers.

The survey found that mental health service use varied significantly among the 17 countries. Overall, fewer people in less developed countries with mental disorders sought services compared with people in developed countries. In addition, the survey found that people in countries spending more of their gross national product (GDP) on health care used services more often. The U.S. population used services more than any other country, at 18 percent. By comparison, 11 percent of France's population used services. The lowest rate of services use was 1.6 percent in Nigeria.

In all countries surveyed, women were more likely than men to seek mental health services. Additional results of countries surveyed found:
• middle-aged people were more likely to receive services than those younger or older;
• people with more education were more likely to seek out services for mental problems; and
• married people were less likely to use mental health services than unmarried people.

— Source: National Institutes of Health

An estimated 8.7% of U.S. children age 8 to 15 meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), but fewer than half receive treatment, according to a report in a recent issue of Archives of Pediatrics & Adolescent Medicine. “Despite widespread concern that the rate of ADHD is on the rise, the national population-based prevalence of ADHD in U.S. children has not [previously] been firmly established,” the authors write in the article. Tanya E. Froehlich, MD, of Cincinnati Children’s Hospital Medical Center, and colleagues studied a group of 3,082 children designed to represent the entire population of 8- to 15-year-olds in the United States. Between 2001 and 2004, children’s parents or other caregivers were interviewed by phone and provided information about each child’s ADHD symptoms, including when they first appeared and any impairment they caused during the previous year. They also reported whether their child had ever been diagnosed with ADHD or taken medicine to treat it, in addition to providing sociodemographic details.

Based on standard diagnostic criteria, 8.7% of the children (equivalent to 2.4 million children nationwide) fulfilled criteria for ADHD in the year prior to the survey. Hispanics were less likely than whites to have ADHD and boys were more likely than girls to meet criteria, although girls who did have ADHD were less likely to have their condition recognized. A total of 47.9% of the children who met ADHD criteria had previously been diagnosed with the condition. The poorest one fifth of children were more likely than the wealthiest one fifth of children to have ADHD. “Reasons for the increased likelihood of ADHD in poorer children may include the elevated prevalence of ADHD risk factors (i.e., premature birth and in utero or childhood exposures to toxic substances) in this group,” the authors write. “In addition, given the high heritability of ADHD and its negative impact on social, academic and career outcomes, it is plausible that families with ADHD may cluster within the lower socioeconomic strata.”

Among children meeting criteria for ADHD, 39% had received some medication treatment and 32% were treated consistently with ADHD medications during the previous year. Despite the prevalence of ADHD in poorer children, they were least likely to receive medications consistently. This finding “warrants further investigation and possible intervention to ensure that all children with ADHD have equitable access to treatment when appropriate,” the authors conclude.

— Source: American Medical Association

A small study suggests that adults whose parents are Holocaust survivors with posttraumatic stress disorder (PTSD) appear to have lower average levels of the stress hormone cortisol than the adult offspring of parents without PTSD, according to a report in a recent issue of Archives of General Psychiatry. Biological differences seen in individuals with PTSD, including low cortisol levels, could either result from exposure to a traumatic event or could be present before such an event and predispose patients to the condition, according to background information in the article. “Once identified, such risk factors may prove to be useful as predictors of who will develop PTSD after exposure to trauma, or they may even identify potential new targets for prophylaxis [preventive therapy] and treatment,” the authors write.

Rachel Yehuda, PhD, of the Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, and colleagues studied 33 individuals whose parents had survived the Holocaust. These study participants were further divided into groups based on whether at least one parent met criteria for PTSD according to a questionnaire completed by the offspring. Twenty-three of the offspring had parents with PTSD, and 10 had parents without PTSD. The researchers measured the participants’ blood cortisol levels every 30 minutes for a 24-hour period, then compared them with the levels of 16 individuals whose parents were not Holocaust survivors. None of the participants had PTSD at the time of the study.

Individuals whose parents had PTSD displayed lower average cortisol levels over the 24-hour period than did those whose parents did not have PTSD or were not exposed to traumatic events. This decrease seemed specifically related to having a mother with PTSD. “Offspring with parental PTSD also demonstrated changes in some chronobiological parameters previously identified as altered in trauma survivors with PTSD despite that no subject had PTSD at assessment,” the authors write. “However, the overall pattern of alterations observed in the offspring with parental PTSD did not follow that reported for PTSD, allowing differentiation between parameters associated with risk vs. those associated with PTSD pathogenesis [development].”

“Although the implications for PTSD prophylaxis cannot be specified from these results, they have clear clinical applications, including assessment of parental PTSD in patients with PTSD and evaluation of stressful events during pregnancy and early childhood,” the authors conclude. “Indeed, the data suggest that examination of epigenetic [environmental or other effect that does not change DNA] or in utero phenomena should be added to the search for genetic polymorphisms that may underlie individual differences that increase vulnerability to this disorder.”

— Source: American Medical Association

Childhood abuse is more common in women with migraine who suffer depression than in women with migraine alone, according to a study published in a recent issue of Neurology. “This study confirms adverse experiences, particularly childhood abuse, predispose women to health problems later in life, possibly by altering neurobiological systems,” says study author Gretchen Tietjen, MD, with the University of Toledo-Health Science Campus and a member of the American Academy of Neurology. Researchers surveyed 949 women with migraine about their history of abuse, depression, and headache characteristics. Forty percent of the women had chronic headache, more than 15 headaches a month, and 72% reported very severe headache-related disability. Physical or sexual abuse was reported in 38% of the women and 12% reported both physical and sexual abuse in the past. These results for abuse are similar to what’s been reported in the general population.

The association between migraine and depression is well established, but the mechanism is uncertain. The study found women with migraine who had major depression were twice as likely as those with migraine alone to report being sexually abused as a child. If the abuse continued past age 12, the women with migraine were five times more likely to report depression. “The finding that a variety of somatic symptoms were also more common in people with migraine who had a history of abuse suggests that childhood maltreatment may lead to a spectrum of disorders, which have been linked to serotonin dysfunction,” says Tietjen. “Our findings contribute to the mounting data that show abuse in childhood has a powerful effect on adult health disorders and the effect intensifies when abuse lasts a long time or continues into adulthood,” says Tietjen. “The findings also support research suggesting that sexual abuse may have more impact on health than physical abuse and that childhood sexual abuse victims, in particular, are more likely to be adversely affected.”

The study also found women with depression and migraine were twice as likely to report multiple types of abuse as a child compared with those without depression, including physical abuse, fear for life, and being in a home with an adult who abused alcohol or drugs. “Despite the high prevalence of abuse and the increased health costs associated with it, few physicians routinely ask migraine patients about abuse history,” says Tietjen. “By questioning women about their abuse history we’ll be able to better identify those women with migraine at increased risk for depression.”

— Source: American Academy of Neurology

Among a growing number of Americans seeking general health information and information about cancer, the Internet remains a frequent first source, even though the public's trust in online material about health has declined, reports a government study. At the same time, consumers voiced greater confidence in information received from healthcare professionals. The report, "Cancer Communication: Health Information National Trends Survey 2003 and 2005," is based on data from the Health Information National Trends Survey (HINTS), a survey done every other year and sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health.

First conducted in 2003, HINTS surveys the U.S. civilian, adult population, to assess trends in the usage of health information over time and to study the links among cancer-related communication, knowledge, attitudes, and behavior. The randomly dialed telephone survey recorded the responses of over 6,300 people in 2003, and more than 5,500 people in 2005. The newly issued report provides a snapshot of how Americans are responding to changes in access to information and the abundance of health information. The data show a growing preference toward receiving health information—whether cancer-related or other health information—from a health care provider than from other sources, such as printed materials, friends and family, information specialists, and the Internet.

Use of the Internet as a source for cancer-specific information remained relatively unchanged during the study period. However, the number of people using the Internet to communicate with their healthcare provider, or their provider's office—e-mailing questions or setting up appointments through a website—increased from 7% in 2003 to 10% in 2005. Use of the Internet to obtain health information about topics other than cancer increased from 2003 to 2005. In 2003, 51% of respondents reported looking for health information for themselves and 46% reported seeking information for someone else. In 2005, the number of people seeking information for others increased to 60%, with 58% seeking information for themselves.

Women were more likely to search for cancer information from all sources than men, and people aged 50 to 64 most frequently searched for cancer-specific information. Younger or more educated people were more frequent users of the Internet for health information. "The survey is not only a surveillance tool, but can be used to study relationships of how knowledge about health care is dependent on channels of communication," says Bradford Hesse, PhD, chief of NCI's Health Communication and Informatics Research Branch.

"Population-based surveys such as HINTS give us a rich source of knowledge about the awareness of the American public," says NCI Director John E. Niederhuber, MD. "Our next step must be to research how best to translate newfound understandings of patterns and preferences into better ways of educating and serving all of our patients through cancer prevention, screening, treatment and survivorship."

— Source: National Institutes of Health

Brain and memory training programs are popular, but they don't work well for everyone, says a Universitiy of Michigan (U-M) psychologist. New research by Cindy Lustig, a U-M assistant professor of psychology, and colleague David Bissig, a U-M graduate now at Wayne State University—U-M's University Research Corridor alliance partner—reveals what can help make a training program successful, especially for those older adults who could use the most help. Their findings are published in a recent issue of Psychological Science.

Programs claiming to "train your brain" are becoming increasingly popular as baby boomers head into their golden years, the researchers say. Even Nintendo has gotten into the game, with a program designed to lower your brain's "age" with repeated playing. However, not all of these programs have been shown to work, they say. For those that do work, scientists' understanding of how and why they work is very limited. Worse yet, the older a person is and the less memory ability he or she has before training, the less likely that person is to show benefits. "The bottom line is that in most memory training programs, the people who likely need training the most—those 80 and older and people with lower initial ability—improve the least," Lustig says.

The researchers, who conducted their studies at Lustig's U-M psychology lab, were able to show that the kinds of strategies people use are related to how much benefit they show from training. Accounting for those strategies can eliminate age and ability differences in training success. Lustig and Bissig took a memory-training program that has been used both with healthy older adults and people in the beginning stages of Alzheimer's disease, and asked what was different about people who showed big benefits from training versus those who showed little or no improvement.

The results of the study suggest that in order to improve memory, one needs not only to work hard, but work smart. People in their 60s and 70s used a strategy of spending most of their time on studying the materials and very little on the test, and showed large improvements over the testing sessions. By contrast, most people in their 80s and older spent very little time studying and instead spent most of their time on the test. These people did not do well and showed very little improvement even after two weeks of training.

One of their conclusions: What matters for memory—and what seems to change as people get older—is not only how much time we spend on trying to remember something, but where we put our efforts. "My lab is now working on training people of more advanced age and lower education to use the strategies that our most successful participants used, to see if we can boost the performance of these potentially at-risk groups," Lustig says. "A stitch in time saves nine—and studying at the right time just might save your mind."

— Source: University of Michigan

Sen Larry Craig’s arrest for alleged gay overtures in a Minneapolis restroom may spell the end of his political career, but some in the lesbian, gay, and bisexual community are hoping the scandal has a silver lining. “Regardless of Larry Craig’s true sexual orientation, the real story here is the extremes that some people must go through to hide their real self from a hostile society,” says James Reid, a clinical psychologist who studies sexual identity and prejudice at Washington University in St. Louis.

“These sorts of encounters take place in the shadows because the social forces of hate are so strong and because people have allowed themselves to be manipulated by the politics of fear and exclusion,” Reid says. “My biggest concern is the effect that the demonization of sexual orientation has on people in this culture.” Reid, a senior lecturer and clinical supervisor in psychology in Arts & Sciences, provides private counseling services for gay, lesbian, and bisexual clients who are struggling with personal challenges related to adjusting to a stigmatized identity. For the last decade, he has taught a course at Washington University on “Lesbian, Gay and Bisexual Identity Development.”

The Craig scandal, says Reid, should force us all to re-evaluate how sexual minorities are treated in a society dominated by heterosexual values. “The issue that should be getting more attention in the coverage of Larry Craig is the secrecy and deceptiveness that our society forces on the homosexual community,” he contends. “In my practice, I talk to all sorts of people who are struggling to be free with who they are, people who are afraid to ‘come out of the closet’ in a hostile work or social environment.”

Reid sees a clear double standard in how society reacts to public figures involved in homosexual vs. heterosexual sex scandals, noting that Republican Sen David Vitter of Louisiana has faced few repercussions from his alleged use of the "DC Madam's" escort service. There’s also a wide variance, he notes, in how police enforce societal norms of what constitutes appropriate sexual behavior.

— Source: Washington University in St. Louis

New research from Northeastern University sociologist Matthew O. Hunt reveals a growing convergence of beliefs among major U.S. ethnic groups regarding what drives the socioeconomic divide between blacks and whites in America. The study, which appears in the American Sociological Review, tracked changes from 1977 to 2004 in Americans’ beliefs regarding why blacks are disadvantaged in areas such as jobs, income, and housing. According to Hunt’s study, whites have shown a decline in support for the belief that socioeconomic inequality is due to an innate or genetic inferiority among blacks. Instead, whites are increasingly likely to blame hindered access to quality education and/or a lack of motivation among blacks as root causes for their disadvantages.

Hunt’s research also reveals a conservative shift in philosophy among African-Americans and Hispanics. Both of these groups—like whites—show increased belief that lack of motivation among blacks is to blame for socioeconomic inequality. At the same time—and unlike whites—African-Americans and Hispanics also exhibit a clear decline in the belief that racial discrimination drives inequality. Of the three groups studied, African-Americans are still most likely to view discrimination—and least likely to view motivation—as causes for socioeconomic inequality.

While significant differences in beliefs remain, Hunt believes these changes demonstrate a convergence of beliefs between minority groups and whites; one that could significantly influence race-based public policy in years to come. “The opinion-shifts for white respondents are mostly continuations of trends we’ve seen in past research,” says Hunt. “What surprised me was the nature and extent of the conservative shifts in views for African-Americans and Hispanics. Given what we know about links between these beliefs and support for public policies designed to counter discrimination, programs such as affirmative action may lose additional ground if Americans’ racial attitudes continue to trend in an individualistic direction.”

— Source: Northeastern University

Shiite vs. Sunni. Red state vs. Blue state. Immigrant vs. native.

While it may appear that conflict is an inevitable part of interaction between groups, research actually suggests that fighting, hating and contempt between groups is not a necessary part of human nature, according to an Ohio State University professor of psychology. “There’s still this belief that a group’s cohesion depends on conflict with other groups, but the evidence doesn’t support that,” said Marilynn Brewer of Ohio State. “Despite evidence to the contrary, you still see this theory in the research literature and in many textbooks.” Brewer has spent much of her career studying “ingroups”—the groups we belong to—and their relations with “outgroups”—those groups to which others belong.

She discussed the nature of these intergroup relations in her invited address at the annual meeting of the American Psychological Association (APA). The address was in honor of Brewer winning the 2007 Distinguished Scientific Contribution Award from the APA. In her address, Brewer said recent evidence suggests that people’s attachment to their ingroups has nothing to do with conflict—or indeed any other kind of relation—to other groups. Instead, people join groups to find a place of trust and security. “Simply put, we prefer people of our kind, people we know we can rely on. That doesn’t mean you have to hate anyone else. But you will be more likely to trust people from your own group,” Brewer said.

In one recent study, for example, Brewer found that people tended to put more trust in total strangers when they learned this stranger attended the same university they did. “All you need is to have that shared group identity,” she said. The evolutionary history of humans suggests there is no need to require intergroup conflict to account for the formation of ingroups. Early humans didn’t live under dense population conditions in which groups had to compete for local resources. Given the costs of fighting, and the lack of need to compete, groups would have been more likely to flee from each other rather than fight.

That doesn’t mean ingroup bias is benign, Brewer said. Ingroup bias is the basis for discrimination, the favoring of people in your group over those in another. “You don’t have to hate people from other groups in order to disadvantage them and to deny them the opportunities you have in your group,” she said. “That’s a real downside to ingroup bias.” Another common misconception about the formation of groups is that people join to boost their self-esteem. In other words, the argument is that the purpose of joining groups is to say “my group is better than your group.” Again, research disproves this theory, Brewer said. “The basic underlying mechanism for ingroup favoritism is trust and security and not self-esteem,” she said.

Research has shown that when people are asked why their ingroup is better than other groups, they focus on traits such as trustworthiness, friendliness and kindness. People don’t necessarily say their group is wealthier or smarter or more successful than others. “Most people are reality bound. They know if their group is not as good as others when it comes to things like wealth, and they won’t pretend otherwise,” Brewer said. “If people were just looking for self-enhancement, they would just say their group is the best at everything, and that isn’t the case. What people are really looking for is trust and security.”

— Source: Ohio State University

Virginia Tech shooter Cho Seung-Hui—a brooding Korean American student who spoke in whispers and never removed his sunglasses—is an extreme example of a common problem. In part because cultural barriers make Asian Americans less likely to seek help for emotional problems than whites, mental health care often fails to reach them says a panel of experts at Alliant International University. “The small amount of research that has been done on Asian and Pacific Islander Americans shows that they don’t use mental health services, and when they do, they often stop treatment before solving their problems,” says Dr. Tai Chang (pictured) of the California School of Professional Psychology (CSPP) at Alliant International University. The Virginia Tech student, who killed 32 students and faculty last April, had been involuntarily committed in 2005, but was never actually treated. Despite the fact that others considered him a danger, he told the clinic he was not having mental difficulties.

“Even when Asian-Americans do seek therapy,” says Chang, “they are less likely than European Americans to reveal their problems, and there are cultural reasons for this: Asian cultures stress ‘saving face’ and relying on family rather than outsiders. While there are many differences between Chinese, Japanese, Koreans, and other Asians, there are important similarities too. There’s a stigma associated with personal problems and Asians also hold beliefs that associate health with the environment, and they equate the physical with the emotional and spiritual.” Chang, an assistant professor in CSPP at Alliant, is the on-site chair of the Asian American Psychological Association Conference.

The US Surgeon General states that Asian Americans and Pacific Islanders have “extremely low utilization of mental health services relative to other U.S. populations,” with 1 out of 2 having difficulty accessing mental health treatment because of language needs. The National Latino and Asian American Study (NLAAS), a study principally funded by the National Institute of Mental Health, found that Asian Americans are unlikely to seek help for mental illness from any source, and when they do, they report low levels of satisfaction. The NLAAS also found that “among Asian Americans and Pacific Islanders who do use services, severity of disturbance tends to be high,” perhaps because they “delay seeking treatment until symptoms reach crisis proportion.”

— Source: Alliant International University

The first comprehensive national survey of sexual attitudes, behaviors, and problems among older adults in the United States has found that most people ages 57 to 85 think of sexuality as an important part of life and that the frequency of sexual activity, for those who are active, declines only slightly from the 50s to the early 70s. Data from the University of Chicago's National Social Life, Health and Aging Project (NSHAP), presented in a recent issue of the New England Journal of Medicine, showed that many men and women remain sexually active—participating in vaginal intercourse, oral sex, and masturbation—well into their 70s and 80s.

The survey also found that sexual activity was closely tied to overall health, which was even more important than age. As health declined steadily after the early 70s, so did the prevalence of sexual activity, particularly for women. Among those who remained sexually active, nearly half reported at least one sexual problem, such as lack of desire (43% of women), vaginal dryness (39% of women), or erectile dysfunction (37% of men). "We found that older adults remain interested and engage in sex, yet many experience bothersome sexual problems that can compromise both health and relationships," says Stacy Tesser Lindau, MD, assistant professor of obstetrics and gynecology and of medicine-geriatrics at the University of Chicago and lead author of the study.

With the first baby boomers turning 60, older adults make up the fastest growing segment of the US population. Yet the "lack of reliable information about how sexual activity and function might change with age and illness, combined with taboos around discussing sex in later life, contributes to worry or even shame for many older adults," she adds. "I am especially happy that we now have in hand reliable and comprehensive information on sexual function and activity among older adults based on a scientifically drawn representative sample of Americans 57 years of age and older," says coauthor Edward Laumann, PhD, the George Herbert Mead Distinguished Service Professor in Sociology and codirector of the 1992 National Health and Social Life Survey, which surveyed persons aged 18 to 59.

"Social relationships are known to contribute to health and well-being in older men and women," says Richard Suzman, PhD, director of the Social and Behavioral Research Program at the National Institute on Aging, which primarily funded the study. "This pioneering research gives us valuable insight into intimate social relationships, providing data clinicians may now draw upon to open better informed conversations with patients about sexuality and health."

"Sexuality is an important part of a healthy and engaged life at older ages for both women and men," says coauthor Linda Waite, PhD, the Lucy Flower Professor in Urban Sociology at the University of Chicago and Director of the Center for Aging at NORC. For the vast majority of men, aging is a partnered experience, "but women's sexuality," Waite says, "is more often affected by the death or poor health of their spouse." The most common reported reason for sexual inactivity among individuals with a spousal or other intimate relationship for men (55%) and women (64%) was the male partner's physical health. Women, especially those who were not in a current relationship, were more likely than men to report lack of interest in sex.

"We hope our findings improve public health by countering harmful stereotypes and allowing older individuals to view their experience relative to others," Lindau says. "It may comfort people to know that they are not alone in enjoying sexual activity as they age or in experiencing sexual problems, some of which could be alleviated with medical attention." This report, according to the authors, provides the first such reference for clinical decision making. It "should improve patient education and counseling," they conclude, and help identify "health related and potentially treatable sexual problems."

— Source: University of Chicago Medical Center

Controversy continues to swirl concerning the findings of a landmark study that estimated the percentage of Vietnam veterans suffering from posttraumatic stress disorder (PTSD). Traumatic stress experts have renewed a clash over the results of the 1988 National Vietnam Veterans Readjustment Study (NVVRS), which originally estimated that 30.9% of veterans endure the effects of PTSD during their lifetime, and that 15.2% still suffered from PTSD more then ten years after the war. The actual prevalence of PTSD in veterans is vigorously debated among the field’s leading researchers, with long-lasting public policy implications for veterans of all U.S. wars, including the current conflict in Iraq. New opinions by several parties involved are reported in a recent issue of the Journal of Traumatic Stress.

Bruce P. Dohrenwend, PhD, of Columbia University, et al. conducted a recent reanalysis of the NVVRS, which found an 18.7% prevalence rate of lifetime war-related PTSD and 9.2% of current PTSD at the time of the study. The authors say that the finding of lower rates is the result only of differences in the definition of the disorder and does not represent a significantly lower total number of soldiers impacted. The key finding of their study, according to Dohrenwend et al., was that the NVVRS confirms a “strong dose/response relationship between severity of exposure to war-zone stressors and PTSD.” The more soldiers are exposed to the horrors of war, the more likely they are to suffer from posttraumatic stress. Richard J. McNally, PhD, of Harvard University, argues that the original NVVRS and the more recent Dohrenwend reanalysis overestimated the prevalence of PTSD in veterans by using faulty criteria for diagnosing the disorder. According to McNally, 5.4% of Vietnam veterans showed clinically significant functional impairment at the time of the NVVRS study.

“Eliminating cases who exhibit no functional impairment is an important way to address a chief concern of the NVVRS’s critics,” says McNally. “Not all emotional changes wrought by serving in a war zone are symptoms of disease or disorder.” A number of experts disagree with McNally’s interpretation of the data, including the original authors of the NVVRS study. William E. Schlenger, PhD, of Duke University Medical Center, et al., claim McNally misrepresents the findings of Dohrenwend et al.’s analysis. “[McNally’s] erroneous statements and misrepresentations seem clearly to be not random,” says Schlenger et al. “Instead, they appear to have been crafted to support a specific bias that has significant policy implications, i.e. that PTSD prevalence among Vietnam veterans is a minor problem, and the real problem is veterans faking combat exposure and PTSD symptoms to qualify for service-connected disability.”

According to Dean Kilpatrick, PhD, of the National Crime Victims Research and Treatment Center Medical University, “In my view, the reexamination by Dohrenwend and colleagues is a major contribution to this public policy debate … It confirms that most veterans of the Vietnam War were resilient, but that an important subset continued to have PTSD over a decade after the war was over.” Despite disagreements on numbers and methods, the experts concur that the government has a responsibility to adequately treat veterans with PTSD. “Regardless of [frequency], the central issue is whether resources are sufficient to meet current demand,” says McNally. “The key question is, 'If a veteran seeks mental health care, will that be able to obtain prompt access to state-of-the-art, evidence-based [care]?' If not, then we must increase resources."

— Source: International Society of Traumatic Stress Studies

New findings that one in 20 North Carolina men who have sex with men (MSM) reported using crystal methamphetamine during the previous month suggests increased risk for spreading HIV and other sexually transmitted diseases (STD), according to researchers from Wake Forest University School of Medicine and colleagues. The rate of methamphetamine use among 1,189 MSM was 30 times higher than levels reported in the general U.S. population over the same period. Methampehtamine, or “meth,” is a highly addictive stimulant that has been found to impair judgment, decrease inhibition, increase impulsivity and enhance sexual sensitivity—which can all increase the potential for transmitting HIV. The study’s authors found that participants who reported using methamphetamines were more likely to report inconsistent condom use during anal sex within the past three months, a history of STD infection, being HIV-positive, and using medications designed to treat erectile dysfunction.

“Until now, there has been little data on meth use in the Southeast,” says lead author Scott D. Rhodes, PhD, MPH, associate professor in the Department of Social Sciences and Health Policy. “Our findings, including that meth users were more likely to be HIV-positive, suggest that prevention, intervention, and treatment efforts are urgently needed.” Rhodes noted that some of the men reported having sex with both men and women, which means the risk of HIV extends to both sexes. The study’s results are published in the current issue of AIDS Patient Care and STDs. It is among the first to document meth use among MSM in the South, which carries a disproportionate HIV, AIDS, and STD burden, with 46% of newly identified cases.

“The findings underscore the need for further research and intervention,” says Rhodes. “The HIV/AIDS epidemic is clearly not over. We must develop innovative intervention approaches designed to reach communities at highest risk. Men who have sex with men, whether or not they identify themselves as gay, who use drugs like methamphetamines are clearly at higher risk. Yet currently nothing is being done in the Southeast.” Participants were recruited in 2005 in five gay bars and in five geographically defined internet chat rooms in central North Carolina (primarily rural/suburban areas) and were asked to complete a brief assessment of drug use and other risk behaviors. Of the 1,189 MSM, two-thirds self-identified as black or other minorities, and 25% as bisexual. The mean age was 29 years. In addition to being more inclined to risky sexual behaviors, the study participants who said they used methamphetamines were also more likely to report having higher education and health insurance coverage.

“Because users of methamphetamines were more likely to have higher educational levels and report having health insurance, we must change the way we think about meth users and develop sophisticated prevention strategies that are appropriate for these types of users,” notes Rhodes. “In addition, the link between meth use and the use of drugs for sexual dysfunction among a young population deserves attention. Meth use in combination with one of these medications may be having an even more profound impact on the HIV and STD disease epidemics in the South.”

— Source: Wake Forest University Baptist Medical Center

A 2002 U.S. Supreme Court decision protecting the right of judicial candidates to speak freely about controversial issues opened the door for state judicial election campaigns to become increasingly nasty, bitter, and politicized. However, the Court's decision has not directly damaged the court system's legitimacy in the eyes of citizens, suggests a new study from Washington University in St. Louis. "While it is certainly true that judicial campaigns have become vastly more costly and more focused on legal and political issues, practically no rigorous evidence has been produced to document the alleged decline in the legitimacy of courts," suggests James L. Gibson, PhD, study author and the Sidney W. Souers Professor of Government in Arts & Sciences at Washington University in St. Louis.

Gibson's findings, to be published in a forthcoming issue of the American Political Science Review, may come as a surprise to legal observers, including former Justice Sandra Day O'Conner, who publicly expressed reservations about her majority decision in the case, known as Minnesota v. White. Under the ruling, state laws forbidding candidates from discussing issues that might come up in future court cases were found to be unconstitutional restrictions of free speech. O'Connor and others worried that the decision might well have unfortunate consequences, causing judicial elections in American states to become so politically tarnished that the very legitimacy of the court system would be undermined in the eyes of voters—can a judge who "panders" to special interests with campaign speeches on "gays, guns and God" be trusted to remain objective when related issues come before the court?

"My analysis indicates that the alarmists are most likely wrong in their concern about perceived judicial impartiality being undermined," Gibson says. "When citizens are exposed to issue-based speech from candidates for judicial office, court legitimacy does not suffer. Indeed, I can find no evidence whatsoever to vindicate the critics of Minnesota v. White. It seems that many Americans are not at all uncomfortable when candidates for the bench tell them how they feel about the sort of socio-political issues coming before courts these days." Gibson bases his conclusions on a comprehensive survey of attitudes among a representative sample of residents in Kentucky, one of the nation's hotspots for bitter judicial election campaigns in recent elections. Some of his additional results are, however, more ominous.

"Although judicial free speech seems not to threaten legitimacy, the study shows that campaign contributions do," Gibson says. "Contributions to candidates for judicial office imply a conflict of interest in the eyes of ordinary citizens, even a quid pro quo relationship between the donor and the judge, which undermines perceived impartiality and legitimacy." However, as Gibson points out, there is nothing distinctive about the judiciary on this score: Campaign contributions to candidates for the state legislature also imply a conflict of interest and therefore can also detract from the legitimacy of legislatures. Not surprisingly, his study documents other unfortunate parallels between judicial and legislative elections when it comes to campaign advertising. "The experiment also indicates that attack ads undermine both judicial and legislative legitimacy," Gibson adds. "The effect is not nearly as great as that observed for campaign contributions, but citizens exposed to such negative advertisements during campaigns extend less legitimacy to the political and legal institutions involved."

The bottom line, Gibson suggests, is that his study confirms that the Supreme Court majority in Minnesota v White was correct in discounting the undesirable consequences of free speech by candidates for judicial office. Preserving the free speech rights of state judicial candidates has not directly diminished America's view of the court system as fair, objective, and impartial.

— Source: Washington University in St. Louis

More than 90% of Americans aged 65 and older now have prescription drug coverage, compared with more than 75% who were covered in 2004, according to a University of Michigan (U-M) analysis. And poor older adults are as likely to have coverage as the rich. The analysis compares drug coverage among a nationally representative sample of 10,175 older Americans who were interviewed both in 2004 and in 2006, when the Medicare Part D prescription drug benefit started. The interviews are part of the on-going Health and Retirement Study, conducted by the U-M Institute for Social Research (ISR) and funded primarily by the National Institute on Aging, "Despite widespread complaints that the Part D plan is complex and confusing, our findings suggest that older Americans have been able to make good choices," says U-M economist David Weir, who directs the ISR Health and Retirement Study. Weir conducted the analysis with U-M economist Helen Levy.

They presented their findings today at the National Press Club, at a conference on "Challenges and Solutions for Retirement Security" sponsored by the Social Security Administration and the Retirement Research Consortium. In 2004, nearly a quarter (23%) of Americans aged 65 and older lacked prescription drug coverage, Levy and Weir found, compared with fewer than 10% in 2006. The overall enrollment figures found in this study were quite similar to those reported by the U.S. Department of Health and Human Services, with roughly a quarter of Medicare beneficiaries enrolled in stand-alone Part D coverage in 2006. But using data from the Health and Retirement Study, the researchers were able to go beyond the official statistics to show that rich and poor were equally likely to sign up for Part D and private coverage, and to lack coverage. Wealthy elders were much more likely to have employer-provided drug coverage, but poorer older adults were much more likely to get drug coverage through Medicaid.

Equally importantly, the researchers were able to show that the most common reason people chose not to obtain prescription drug coverage was that they used few or no drugs. While Levy and Weir caution that their analysis is preliminary, the findings indicate that despite widespread criticisms, the Part D plan has succeeded in boosting drug coverage for U.S. older adults, especially for those who need it most. "Fewer than 10% of older adults lack drug coverage now," Weir says. "And those with worse self-reported health and higher use of prescription drugs in 2004 were more likely than others to sign up."

— Source: University of Michigan

Providing family therapy to seriously ill children and their families consistently enhances medical outcomes and increases the overall mental health for adolescent patients, family, and treatment professionals, Texas Tech Marriage and Family Therapy faculty found through a unique partnership integrating family counseling as part of medical treatment. “Medical family therapy is a proven benefit for children and families dealing with a serious illness,” says Linda Hoover, dean of the College of Human Sciences. “With this new research, we can begin treating more children and their families and hopefully improve recovery and responsiveness to illness.”

The research, examining the effectiveness and utility of family therapy in treating seriously ill children, was presented in “The Integration of Family Systems with Intensive Pediatric Health Care: The role of family therapy in the treatment of seriously ill children.” The findings resulted from a unique partnership in which Texas Tech marriage and family therapists provided counseling to families dealing with an adolescent illness, integrating counseling as a core treatment component. More than 300 families have participated in the treatment process through this partnership, established in 2005 between Texas Tech and Covenant Children’s Hospital. Therapists are integrated into daily treatment routines and schedules in order to serve the families and children throughout the illness.

Researchers found that by providing medical family therapy to pediatric intensive care patients, pediatric oncology patients, and neo-natal intensive care units, families were better able to cope. Results were measured both quantitatively and qualitatively through satisfaction questionnaires, treatment responsiveness, and measurement of medical results. “We have consistently seen the benefits of medical therapy to our patients and their families as they go through challenging times,” says Melanie Oblender, MD, chief of staff for Covenant Children’s Hospital and pediatric oncologist. “Our goal is to continue to implement these therapists as a core part of the treatment team in order to better aide patients through the treatment process.”

— Source: Texas Tech University

For years, scientists have known that some people are biologically more susceptible to drug addiction than others, but they have only been able to speculate why. In a recent issue of the Journal of Neuroscience, researchers at the University of Chicago report on a study that may help answer this question. They discovered that rats most likely to self-administer addictive drugs had a particular receptor in the brain that is more responsive than the same receptor in rats least likely to self-administer addictive drugs. This receptor, known as the nicotinic acetylcholine receptor (nAChR), increases excitability within in the brain’s reward centers. In the animals that were more likely to take addictive drugs, the effects of these receptors were much stronger, leading to more profound excitation of the cells and pathways associated with reward.

Stress, and the associated increases in stress hormones, will promote drug-taking behavior regardless of whether an animal is more or less susceptible, say the researchers. They showed that stress also increases the responses of nAChRs within the brain’s reward areas. "We tested the exploratory behavior of rats in an unfamiliar cage. Rats that explore a new environment for a prolonged period of time were more interested in addictive drugs," says Daniel McGehee, PhD, associate professor and the study’s lead researcher. "Those rats also had stronger nAChR responses, meaning their brains responded differently to the drugs. We measured receptor activity in the brain’s reward centers that are known to be activated by addictive drugs."

"This study provides valuable insight into the mechanism of addiction," says McGehee. "It raises the possibility that nicotinic receptors may be important targets for the treatment of multiple addictions, not just nicotine. Unfortunately, blocking these receptors may also interfere with healthy behaviors that depend upon the same brain circuitry. Precisely where these findings will lead drug treatment strategies is unclear, but this work provides insight into the role of nicotinic receptors in the vulnerability to multiple classes of addictive drugs."

— Source: University of Chicago Medical Center

Researchers and government officials have known for two years that Hurricane Katrina caused population shifts across the Gulf Coast region, but University of Mississippi (UM) researchers have quantified just how sharp the decline has been in affected areas. Their work also has provided new insights into the importance of social networks and family connections in helping people prevail through disastrous circumstances. David A. Swanson, director of UM’s Center for Population Studies, plans to share these findings through “The Gulf States Alliance: Network Science and Recovery Forum.” Swanson teamed with faculty colleagues Mark Van Boening, chair of economics, and Richard Forgette, chair of political science, to prepare the report on the preliminary research that assessed Hurricane Katrina’s demographic and social impacts on the Mississippi Gulf Coast.

“Hurricane Katrina represents the greatest natural disaster in American history and stretched 90,000 square miles, roughly the size of Great Britain,” says Swanson, also professor of sociology and anthropology. The professors compared the number of houses in the Mississippi counties of Hancock and Harrison from Census 2000 and after Katrina’s landfall on Aug. 29, 2005. They worked on a block-by-block basis to determine the total number of houses destroyed or damaged, also breaking the figures down by type of housing unit. Their research found that just before Katrina 18,105 people occupied approximately 7,100 housing units in the area. By January 2006, that number had fallen to approximately 10,950 people residing in 3,938 permanent and temporary housing units. Thus, the hurricane resulted in a population decline of 7,155 people in these 346 blocks.

Also, Swanson, Van Boening and Forgette collected data to determine whether social and kinship networks played roles in determining respondents’ success; that is, the capacity for respondents to sustain their physical and emotional well-being after the hurricane. The study found that individuals with a large network of friends and family experienced less post-traumatic stress following the storm, Forgette says. “Most people consider individuals with physical limitations, limited finances or the elderly as those most vulnerable to unexpected events like a natural disaster,” Forgette says. “Our research shows that people with low social networks or relationships reported disturbance in financial, economic, physical and professional well-being.”

Swanson agrees, adding, “Our data indicates that social isolation increases perceptions of disaster disturbance. Our findings show that a person with a large personal network group, including friends, church, plus immediate and extended family, was more able to deal with the impact of Hurricane Katrina on an economic, health and social well-being level than a person with a smaller personal group network,” Swanson says.

— Source: University of Mississippi

Therapy techniques that focus on family dynamics and structure can successfully be applied by organizations to increase employee satisfaction and alter employee attitudes, a team of Texas Tech University researchers has found. Texas Tech Marriage and Family Therapy faculty, working with colleagues from the Texas Tech University Health Sciences Center, identified methods of family systems-based therapy that can be used throughout organizational intervention programs. Researchers focused on family-based theories of the whole being greater than the sum of its parts, status quo, and interactive feedback as effective methods in treating organizational problems. The findings were published earlier this year in the Journal of Marital and Family Therapy.

“This new research based on family systems methods opens a new window of opportunity in organizational intervention,” says Linda Hoover, dean of the College of Human Sciences at Texas Tech. “Therapists participating in organizational intervention programs can use these new methods to help increase professional environments and productivity.” These intervention methods view the family as a whole unit and evaluate problems based on organizational structure, boundary ambiguity, unclear rules, hierarchy, and the exercise of power—all of which also occur throughout professional organizations. The group hypothesized that the difficult problems existing within organizations were caused not only by individuals but also by relational and systemic processes.

Data was collected while the group worked with the Texas Tech Employee Assistance Program. The team found these methods as an effective way of increasing employee satisfaction and altering employee attitudes. The most impact occurred when not just the individual was considered but also the individual’s relationships to others. Organizational intervention is one of the many services that has historically been provided by the Texas Tech Employee Assistance Program to administrators on the university campus and to other business and governmental entities in the community. The model that resulted from these studies provides both the general guidelines and specific interventions for ongoing organizational consultations, both within the Lubbock community and across the country.

— Source: Texas Tech University

Older white men who are better able to cope with stress experience higher levels of so-called “good cholesterol” than men who are more hostile or socially isolated, according to a recently released study. But that same coping ability had no effect on the subjects’ “bad cholesterol” levels, the research found. Researchers gathered data from 716 men who participated in the Normative Aging Study to look at the complex interrelations among hostility, stress, and coping processes and cholesterol levels. The average age in the sample was 65. Most of the men were white and were evenly split between white-collar and blue-collar occupations.

The subjects were given a questionnaire that asked them to rate how often they used 26 coping strategies. Individuals high in hostility were more likely to perceive problems as stressful and react with negative behavior, self-blame and social isolation. Men who were better able to cope could make a plan of action and pursue it, for example. Following an overnight fast, the subjects’ blood was tested for high-density lipoproteins (good cholesterol), low-density lipoproteins (bad cholesterol) and triglycerides. The authors had theorized that hostility would have an effect on all three lipoproteins, but what they found was a direct effect on HDL and triglycerides, but not on LDL. “It is interesting that the coping variables were most strongly associated with this protective factor,” they wrote. “The results of our study suggest that coping processes also might influence lipid fractions differently and may play a protective role through their influence on HDL.”

Loriena A. Yancura, PhD, the lead researcher, from the University of Hawaii at Manoa, says she and her colleagues were surprised that there were no associations between coping and the LDL levels. “One possible reason might be that measures of hostility, coping, and lipids were taken at one point in time,” she says. “In other words, we asked people about their coping strategies in response to a problem in the past month and looked at a blood sample taken at the time we asked them. It is possible that changes in LDL might have been apparent in a lab setting or if we had looked at longitudinal relationships among hostility, coping, and lipids.”

— Source: American Psychological Association

Ineffective or even dangerous fad treatments for autism, always a problem, seem to be growing more pervasive, according to researchers. “Developmental disabilities like autism are a magnet for all kinds of unsupported or disproved therapies, and it has gotten worse as more children have been diagnosed with autism,” says James Mulick, professor of pediatrics and psychology at Ohio State University. “There’s no cure for autism, and many parents are willing to believe anything if they think it could help their child.” Tracy Kettering, a doctoral student in special education at Ohio State, says a Google search for the phrase “autism treatment” yields more than 2.2 million matches. “You get hundreds of different types of therapies that come up, and many have quotes from parents that claim a particular therapy ‘cured’ their child,” Kettering says. “It’s no wonder that parents want to believe. But very few of these treatments have any evidence to support them.”

The number and range of fad treatments has seemed to grow in recent years as more children have been diagnosed with autism, says Mulick, who is also editor of a book on fad treatments called Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice. Mulick says when he began treating autism in the 1970s about 3 children in 10,000 were said to have autism. Now, reports are 1 in 166 children have the condition. The number of cases has mushroomed because of better diagnoses, and a changing definition of autism that includes a broader range of disorders. Some of the newer, more popular fad treatments for autism involve special diets or nutritional supplements. Megadoses of Vitamins C and B6 are popular, as well as supplements with fatty acids like omega-3s. A casein and/or gluten-free diet, which involves eliminating dairy and wheat products, has also gained favor with some parents. While many of these treatments have never been adequately studied, that doesn’t mean they aren’t promoted. “One of the characteristics of fad treatments is that they are discussed in the media and on the internet, where many parents can be exposed to them,” says Anne Snow, an Ohio State psychology graduate student.

Many parents try multiple approaches, hoping at least one will help. Kettering says one survey she found suggests that the average parent of a child with autism has tried seven different therapies. “We’re not saying that all of these treatments don’t work or that they are all dangerous,” Kettering says. “But the research hasn’t been done to suggest that most of them are effective or even safe.” Many of the treatments may have just enough basis in scientific fact to attract attention, even if the treatment itself is unproven. For instance, most scientists believe that many cases of autism are caused by genetic mutations, and some mutations can be caused by various chemicals that we encounter in our everyday lives, Mulick says. But still, there is no evidence that any particular chemical causes mutations that lead to autism, as some have claimed. “There’s a shred of truth in the rationale presented for some fad treatments, and that is enough for some people to go with,” he says.

Another reason that fad treatments persist has to do with the natural course of autism, Mulick says. Autism, like many conditions, has cycles in which symptoms get worse and then get better. Parents tend to search for treatments when symptoms are getting worse, and when their children get better—as they do in the normal course of disease—parents credit the new therapy. “It’s natural to have this bias that the therapy you’re trying has had some positive effect,” he says. “People want to believe.”

— Source: Ohio State University

Painful, emotional memories that people would most like to forget may be the toughest to leave behind, especially when memories are created through visual cues, according to a new study by the University of North Carolina at Chapel Hill. “When you’re watching the news on television and see footage of wounded soldiers in Iraq or ongoing coverage of national tragedies, it may stick with you more than a newspaper headline,” says the study’s lead author Keith Payne, an assistant professor of psychology in the College of Arts and Sciences. It is adaptive to be able to intentionally forget neutral events such as wrong directions, a friend’s outdated phone number or a switched meeting time. Intentional forgetting helps update memory with new information, Payne says.

But Payne and former psychology graduate student Elizabeth Corrigan found that even “mild” emotional events, like getting a bad grade on a test or a negative comment from a coworker, can be hard to forget. Their study, “Emotional constraints on intentional forgetting,” appears in a recent issue of the Journal of Experimental Social Psychology. When people are trying to intentionally forget information, they need to mentally segregate that information and then block off the information they don’t want to retrieve, Payne says. Emotion undermines both of those steps. “You make a lot of connections between emotional events and other parts of your life, so it might be difficult to isolate them. As far as blocking retrieval of an unwanted event, emotion makes events very salient and therefore highly accessible,” Payne says.

Their results contrast with previous studies of emotional events and intentional forgetting, but those studies used emotion-laden words as stimuli, like “death” and “sex.” The UNC study took a new approach, asking 218 participants to react to photographs instead of text. “The word ‘murder,’ for instance, may or may not make you afraid, but if you see a graphic, violent picture, it may be powerful enough emotionally to change the way you feel,” Payne says. The researchers found that their subjects could not intentionally forget emotional events as easily as mundane ones. They also found that both pleasant and unpleasant emotional memories were resistant to intentional forgetting.

The UNC findings contribute to understanding the ways that emotion constrains mental control and to the question of whether intentional forgetting can be helpful in coping with painful or traumatic experiences. “Our findings add to accumulating evidence that emotion places limits on the ability to control the contents of the mind,” Payne said. “Our results suggest that even a relatively mild emotional reaction can undermine intentional forgetting. But this doesn’t necessarily mean that emotional memories can never be intentionally forgotten. If the motivation to forget is powerful enough, individuals might be able to overcome the effects of emotion by enlisting additional coping strategies.” A different study would be needed to examine what treatment and coping strategies might be effective in helping people voluntarily forget an unwanted memory, he added.

— Source: University of North Carolina at Chapel Hill

The evidence is accumulating on how bad stress is for health. Chronic stress can intensify inflammation and increase a person’s risk for developing central nervous system infections, neurodegenerative diseases, like multiple sclerosis (MS), and other inflammatory diseases, say researchers. These researchers have demonstrated for the first time that stress-related increases in central nervous system inflammation are behind the adverse effects of stress in an animal model of MS. Researchers from Texas A & M University used mice to show what role social stress plays in the immune process to influence the course of an MS-like disease. They proposed that stress-induced increases of pro-inflammatory cytokines, which are proteins that regulate immune and inflammatory functions, inhibit the clearing of a virus and allow the inflammatory process to run amok. Stress, say the authors, may interact with viral infections to increase vulnerability to diseases such as MS. Meta-analysis of studies investigating the impact of stressful events in patients with MS show an increased risk of worsening symptoms of the disease.

In a series of experiments on mice, the authors showed that increases in a particular cytokine—interleukin-6 (IL-6), which is released during stress and regulates the part of the immune system that fights infection—can make socially stressed mice vulnerable to MS-like illnesses. The researchers used a social disruption model (SDR) to simulate social stress for mice and then infected the mice with Theiler’s murine encephalomyelitis virus (TMEV). Infection with TMEV results in an acute infection of the central nervous system followed by a chronic autoimmune disease similar to that seen in humans with MS. Their laboratory has previously shown that exposure to social stress prior to infection exacerbates both the early viral infection and the later autoimmune demyelinating MS-like phase of the disease.

What they found was stress appears to elevate levels of IL-6, which subsequently increases the severity of the MS-like illness. Furthermore, using specific IL-6 neutralizing antibody treatments during the stress exposure can prevent the stress-related worsening of the disease, say the authors. In one experiment, they showed that mice exposed to social disruption had elevated central and peripheral levels of IL-6. However, infusing the neutralizing antibody into the brain prevented this stress-induced increase in IL-6. This demonstrated that the antibody could effectively reverse the stress-related increases in IL-6 in brain and circulating blood. Results from a second experiment showed that administering the IL-6 neutralizing antibody during the stress exposure prevented worsening of the TMEV infection. By blocking the stress-induced elevation of IL-6, TMEV infection was weakened, which lessened some of the disease symptoms, such as motor impairment, inflammation in the brain and spinal cord, and the viral level in the central nervous system.

There is a growing body of evidence in both animal and human studies that suggests that exposure to stress can increase and sustain the release of pro-in?ammatory cytokines following an assault on the immune system. Thus, the present findings might help scientists unravel which biobehavioral mechanisms offset the adverse health effects of chronic social stress in humans. “Similar to mice exposed to repeated social defeat by an aggressive intruder, people exposed to chronic social conflict experience high levels of stress and consequent dysregulation of the immune system, thereby increasing vulnerability to infectious and autoimmune disease,” says Meagher. “The cytokine response during chronic stress appears to play a key role in exacerbating the acute CNS infection and the development of subsequent autoimmune responses.”

— Source: American Psychological Association

In the summer of 1967, seven months before his death, Dr. Martin Luther King Jr. addressed the American Psychological Association (APA) annual meeting outlining the important role he believed psychologists and other social scientists should play in helping the United States overcome the legacy of slavery and continued racism. King asserted that the promotion of mental health and psychological development was largely contingent on society’s ability to afford opportunity and justice for all of its citizens. King challenged his APA audience to expand their scope beyond traditional work settings in order to acquire culturally competent skills and have a wider impact. He wanted social scientists to study and support specific structural changes, such as strategies to reduce earnings, health, and educational disparities, that would foster the psychological wellbeing of large segments of society. King acknowledged that many within the white majority would have difficulty accepting such change but that it was up to social scientists to study such resistance and help people overcome it.

“In Dr. King’s day, most psychologists of the time were generally uninterested in implementing new professional roles that could help ameliorate the complex problems of racial and structural inequities that existed in the ’60s,” remarks Michael D’Andrea, PhD, a professor of psychology at the University of Hawaii and the executive director of the National Institute for Multicultural Competence. “What Dr. King saw that others had to learn was that individuals could realize new and untapped dimensions of their psychological health when they worked collectively to ameliorate the various forms of violence, injustice and oppression that diminish people’s sense of dignity and value as human beings.”

In 1967, King also called on social scientists to help build an understanding of the underlying causes of the urban violence and inner city rioting of the period. He spoke of the need for social scientists to address what he called the “three pillars” of oppression and mental disorder in society. King wanted psychologists to study the interlinkages among the complex problems of racism, classism, and militarism. Today, 40 years later, there is a growing body of published research that supports King’s hypothesis. Currently, hundreds of studies, most published in psychological and medical journals within the last ten years, document the effects of racial discrimination on physical health including blood pressure and heart disease. While some health experts regard this evidence as preliminary, others now consider racism to be a health risk and a public health problem.

King would be pleased with the advancements made within the fields of counseling and psychology toward more cultural awareness, inclusion and competency, but more work has to be done, according to APA members. “One of modern psychology’s most important contributions is its understanding of how individuals form their racial and cultural identities as well as their attitudes about in-group and out-of-group behavior and characteristics, states Parham. “What I would like to see my colleagues attack next is a better understanding of the complex ways in which racism, sexism, ableism, classism, and heterosexism continue to manifest themselves as new forms of injustice in our contemporary society. Particular attention needs to be directed to the manner in which these new forms of injustice undermine the mental health not only of persons in marginalized groups but of those within the majority group who consciously and unconsciously hold on to discriminatory views,” Parham concludes.

— Source: American Psychological Association

Depression may be an unrecognized readjustment problem for recently returning veterans of the conflicts in Iraq and Afghanistan, according to a study released at the American Psychological Association 115th Annual Convention. Researchers working with veterans referred for psychiatric evaluation from a primary care service found that major or minor depression was associated with domestic abuse and other family problems. The researchers, at the University of Pennsylvania and the Mental Illness, Research Education, and Clinical Center at the Philadelphia VA Medical Center, looked at the family problems of 168 veterans who were referred for behavioral health evaluation and who had served in Iraq or Afghanistan since 2001. More than 40% were currently married or cohabiting, some 21% were recently separated or divorced and almost 55% had at least one child.

Two thirds of the married/cohabiting veterans reported some type of family readjustment problem or conflict occurring several times a week: 42% felt a like a guest in their household, 21.8% reported their children were not acting warmly or were afraid of them, and 35.7% were unsure about their role in regular household responsibilities. Veterans with depression or PTSD were more likely to experience these readjustment problems. The presence of family problems may limit the effectiveness of treatments for depression or PTSD because of the importance of positive family relationships to veterans’ recovery. According to the researchers, the results suggest an opportunity to improve treatment for returning veterans by involving family in the veteran's recovery.

In addition, about 56% of the patients with current or recently separated partners reported severe conflicts involving “shouting, pushing, or shoving,” and 35% reported that this partner was afraid of them. The researchers, led by Steven L. Sayers, PhD, of the Philadelphia VA Medical Center, noted that while there has been very little empirical research focused on the family problems of veterans in the first year or two following their return from a major military conflict, family problems among those with partners are common. The rates of problems found in this study were similar to those in longer-term studies of Vietnam veterans diagnosed with PTSD.

“In the current study, however, we did not find that PTSD was associated with overall rates of family problems,” the researchers wrote. “In contrast, depression was most consistently related to the presence of both readjustment and domestic abuse problems.” Many of the veterans at the Medical Center with PTSD were already in treatment in the Behavioral Health Service and so were not part of this primary care sample referred for evaluation. The researchers found that specific role-related readjustment problems were related both to depression and PTSD. For example, whereas about 20% of the veterans reported that their children were afraid of them or did not act warmly, those with PTSD were at greater risk of this experience (36%).

— Source: American Psychological Association

Children whose mothers are depressed are less likely to develop problem behaviors if their fathers are actively engaged in family life, a Saint Louis University researcher finds. It is well documented that children living in homes with depressed mothers are at increased risk of developing problems such as aggression, hyperactivity, depression and anxiety. However, an involved father—one who has a positive relationship with his children—may reduce the risk of those behaviors.

The 10-year, population-based study published in a recent issue of the Archives of Pediatric and Adolescent Medicine, is the first to examine a father’s role in a household with a depressed mother. “My study corroborates findings from previous research that a child is at increased risk of problem behaviors when the mother is depressed,” says Jen Jen Chang, PhD, assistant professor of community health in epidemiology at the Saint Louis University School of Public Health and principal investigator. “But once we factored in a father’s positive involvement, I observed that the adverse impact of the mother’s depression was attenuated. The father served as a buffer. He may have engaged with the children when the mother wasn’t available due to her illness.” The level of a father’s involvement was based on questions given to children aged 10 and older. Investigators asked the children how often their father talked over important decisions with them; whether he listened to their side of an argument; whether he knew where they were when not at home; whether their father missed events or activities that were important to them; and how close they felt to their father.

Chang’s study is unprecedented not only because it examined a father’s role in a household with a depressed mother but because it followed the children with multiple assessments throughout childhood and adolescence in a continuous context. Her results drew on data from the National Longitudinal Survey of Youth (NLSY), an ongoing government-funded study of ethnically and economically diverse men and women and their labor market experiences. The NLSY contains detailed information about the biological children of these men and women, including each child’s behavioral and social functioning. Chang’s sample included 6,552 mother/child pairs. Child behavior problems were assessed every two years.

Chang said results of her study have important implications for intervention. “I would advocate for health professionals to educate parents, specifically fathers, to be more involved with their children when their wives are diagnosed with depression. Mothers play an important role in a child’s life. When she’s mentally ill, the child is going to have difficulty, the whole family suffers. Fathers are in a position to negate that but may need a health professional’s guidance.” Chang says her study was inspired by her family experience. Her sister suffered from mental illness and Chang witnessed how difficult the illness was on her sister, her family, and her sister’s family. “My research has become a personal quest and I hope it will bring more focus to the issue of maternal depression,” she says. “Healthcare professionals must do a better job of screening for this debilitating and under-diagnosed illness.”

— Source: Saint Louis University Medical Center

Students in “year-round” schools don’t learn more than their peers in traditional nine-month schools, new research has found. Paul von Hippel, author of the study and research statistician in sociology at Ohio State found that, over a full year, math and reading test scores improved about the same amount for children in year-round schools as they did for students whose schools followed a traditional nine-month calendar. “We found that students in year-round schools learn more during the summer, when others are on vacation, but they seem to learn less than other children during the rest of the year,” says von Hippel. The problem with year-round schools may be that they don’t actually add more school days to the 180 typically required, von Hippel adds. Instead of a three-month summer vacation, year-round schools typically have several breaks of three to four weeks spread throughout the year. The total number of school days and vacation days remains unchanged, but they are distributed more evenly over the calendar.

Although school districts often adopt year-round schedules to help alleviate overcrowding, some educators have claimed that eliminating the long summer vacation will provide academic benefits for students. “The results don’t support that claim,” von Hippel says. One supposed benefit of year-round calendars is that they do away with the slowdown or loss of learning that students commonly experience over the summer. But “year-round schools don’t really solve the problem of the summer learning setback—they simply spread it out across the year,” he says.

The study used data from the Early Childhood Longitudinal Study, a national survey conducted by the U.S. Department of Education. Von Hippel examined reading and math test scores of children in kindergarten and first grade in 748 public schools and 244 private schools from around the country. Scores from students in 27 public schools classified as year-round (none of the private schools had a year-round calendar) were compared with scores of students in schools with traditional calendars. Nearly all of the year-round schools were in urban and suburban areas, and most were in the West. Children attending year-round schools were mostly Hispanic and tended to be somewhat poorer than average, but their poverty was moderate rather than severe. Year-round schools also tended to have problems with overcrowding. In fact, year-round schedules are often adopted to cope with crowding. By staggering students’ schedules, year-round schools can arrange for some students to be in session when others are on vacation; in this way, schools can accommodate more students than they could on a traditional nine-month calendar.

Von Hippel says he was able to take into account issues such as poverty and overcrowding when comparing scores to ensure that comparisons between test scores in year-round and traditional schools were fair. Reading and math tests were given to students at the beginning and end of kindergarten and first grade; comparing these test scores allowed von Hippel to estimate the amount learned during kindergarten, during the summer between kindergarten and first grade, and first grade. Over a twelve-month period, average test score gains were less than 1% larger in year-round than in nine month schools—which von Hippel says is “an absolutely trivial difference.”

Some proponents of year-round schools argue that they may do the most good for students that come from especially poor families. This study found mixed results for that argument, he says. Compared with other students, disadvantaged children did seem to gain slightly more in reading test scores in year-round schools than they did in nine-month schools. However, these students from poor families saw no increase in math scores in year-round compared with traditional schools. “There may be a slight advantage for students from the poorest families in attending year-round schools, at least when it comes to improving their reading,” he says.

While the results of the study contradict one major argument for year-round schools, von Hippel says this should not be taken as an argument against year-round schedules. “On purely academic grounds, I wouldn’t advocate a year-round calendar, but I can’t recommend against it, either,” he says. If a school has a non-academic reason for adopting a year-round calendar—such as coping with overcrowding—it can do so without any major harm to academics. And if it already has a year-round calendar, there is no academic reason to switch back. “On the other hand, if a school is considering a year-round calendar in hope of boosting academic achievement, it seems unlikely that those hopes will be realized,” von Hippel says.

— Source: Ohio State University

A new study suggests that women with chronic issues with their body image are more likely to benefit from an exercise class where the instructor emphasizes the health benefits of the workout over improved appearance, even if those women chose the class in hopes of improving their physique. Researchers studied nearly 100 college-aged women who had social physique anxiety—a disorder in which someone chronically worries that others are critiquing his or her body. “Women who have this disorder usually are interested in exercise to improve their appearance, but an instructor who emphasizes physique during a workout may deter such students from coming back,” says Brian Focht, a study coauthor and an assistant professor of health behavior and health promotion at Ohio State University.

Women in the study reported that they enjoyed a step-aerobics class more when the instructor focused on the health-related aspects of the workout, telling them how exercise will make them more fit. These same women were more likely to say that they would try a similar class in the future, compared with the women who were taught by an instructor who emphasized appearance by making comments about how the exercise would tone their legs or other body parts. “We want to design the most beneficial exercise programs for different groups of people, and understanding how people respond to different approaches to exercise is key to doing so,” Focht says. “We chose a very specific sample of women that we thought would be sensitive to the comments made by instructors.”

The study’s results appear in a recent issue of Psychology of Sport and Exercise. Focht conducted the study with Thomas Raedeke and Donna Scales, both researchers at East Carolina University, in Greenville, N.C. All women enrolled in a required physical activity course at the university answered a questionnaire on exercise and body image. A woman’s answers indicated if she had social physique anxiety. Only those women with the disorder were asked to participate in the study. The average age of the 99 participants was 19. Their average body mass index was 24.7, which is within the ideal range for body size. The women reported that they worked out at moderate or vigorous intensity about 3.3 times a week. The women participated in one of four 45-minute step-aerobics classes. The same instructor taught each class, although she emphasized health over appearance in two of the classes. In the other two classes, she emphasized appearance over health. One class in each scenario included a mirror. “There is a fair amount of research that suggests that mirrors in a workout room can negatively affect how someone feels, particularly a woman who is concerned about her physical appearance,” Focht says.

About five to 10 minutes after class each woman filled out the Exercise-Induced Feeling Inventory. This questionnaire measures how someone feels after exercising, whether revitalized, physically exhausted, tranquil, etc. The women also answered questions on the Physical Activity Enjoyment Scale, whereby each woman rated how much she enjoyed the class, and whether she would likely participate in a similar class in the future. The results of both surveys suggested that the instructor’s leadership style directly affected the student’s attitudes toward the class. The women in the health-oriented class reported that they felt more engaged in the workout as well as revitalized and less exhausted after class than did the women in the appearance-oriented classes.

The participants in the health-oriented classes reported that they also enjoyed the workout more and would be more likely to take a similar class in the future. Focht and his colleagues were surprised to find that the presence of mirrors in the exercise room didn’t influence how the women felt during class. “We expected the mirrors to have some effect on these women, but that wasn’t the case,” he said. “It was the instructor’s leadership style that had a direct effect on the students’ attitudes.” Focht also says that fitness instructors don’t need to throw out every appearance-related comment during class, but suggests that they be judicious in their use of such dialogue.

— Source: Ohio State University

Nine percent of young people in a New York City study of lesbian and gay youths meet the criteria for posttraumatic stress disorder (PTSD). The research found that for nearly one in ten of the young participants, experiences growing up lesbian or gay are linked to the same condition that affects many adults who are the victims of violent crime or are in an accident or natural disaster. “These results join the growing body of data suggesting that violence directed at young people who are lesbian, gay, or bisexual has a significant negative effect on their mental health,” says Robert-Jay Green, PhD, executive director of the Rockway Institute, a national research and public policy center located at Alliant International University. “Many adults overlook such abuse, considering it an expected, normal part of childhood teasing. For the targets of this kind of aggression, however, it can be associated with serious psychological harm.”

The study was conducted by Anthony R. D’Augelli and Michael Starks of Penn State University and Arnold Grossman of New York University and published in the Journal of Interpersonal Violence in November 2006. The research examined 528 New York City area youths aged 15 to 19 who were victimized based on their sexual orientation or whether they appeared to their peers to be “sissies” or “tomboys.” Participants were interviewed three times during a two-year period. Three-fourths of the youths said they felt different from their peers as they were growing up. On average, the realization they were different occurred at about age 8. Parents noticed these differences, and few reacted positively to the possibility that their child was gay. Youths typically delayed “coming out” to their parents until age 14 or 15. Nearly one third of youths who were called “sissies” or “tomboys” by their peers said their parents tried to encourage traditional sex role behaviors.

Nearly 80% of the young people reported verbal taunts, some beginning as early as age 6. The average age that this gay-related verbal abuse started was 11 for males and 14 for females. More than 70% of these verbal incidents occurred at school. Nearly three quarters (73%) said they were very or extremely upset by the verbal victimization. Fourteen percent of participants reported physical attacks, some as young as age 9. Males were most victimized by other males, while females were victimized almost equally by males (53%) and females (47%). Violence occurred most often at school (56%) or in a public setting (25%). Most participants (89%) said they were very or extremely upset by the physical victimization. For nine percent, the victimization was sexual. Incidents occurred earlier for males (aged 13) than for females (aged 16). All of the attackers were male, and the most likely setting was at home (34%). Nearly all of the young people (97%) said they were very or extremely upset by the sexual victimization.

The study found that earlier victimization, the perception of these early experiences as highly upsetting, and the lifetime accumulation of victimization events are factors that can create long-term psychological distress. Overall, the study found 9% of participants met the criteria for PTSD as defined by the diagnostic manual of the American Psychiatric Association. Of those who had been called “sissy” or “tomboy,” the figure was 12%. PTSD was associated with increased physical victimization and with the degree of upset experienced. Thus, concluded the researchers, youth who are less gender typical in childhood and who are victimized may have elevated mental health and trauma symptoms, and some may have PTSD.

Overall, the study found 70% of verbal victimization and 56% of physical victimization occurred in schools. Noted Green, “These data again point to an urgent need for training school administrators, teachers, and counselors to stop the bullying of lesbian and gay youths. Every child has a basic right to a safe learning environment free from verbal harassment and physical violence. Nobody, regardless of his or her political views on gay issues, wants to see these children hurt. It’s high time that school officials and shapers of education policy ensured safety for all of our children.”

— Source: Alliant International University

By the time they reached adulthood, graduates of an intensive early childhood education program for poor children showed higher educational attainment, lower rates of serious crime and incarceration, and lower rates of depressive symptoms than did non-participants in the program, reported researchers in a study funded in part by the National Institutes of Health. The Child-Parent Centers (CPC) program in the Chicago Public School System provided intensive from pre-kindergarten through third grade, combined with frequent educational field trips. The children's parents received job skills training, parenting skills training, educational classes and social services.

"These results strongly suggest that comprehensive early education programs can have benefits well into adult life," says Duane Alexander, director of the National Institute of Child Health and Human Development, the NIH institute that funded the study. "A comparatively small investment early in life is associated with gains in education, economic standing, mental health, and other areas." The researchers followed the children from ages 3 or 4 through age 24 to assess the possible benefits of the CPC program in terms of the children's educational achievement, need for remedial education, involvement with the child welfare and foster care system, economic status, involvement with the criminal justice system, health status and mental health. The study appears in a recent Archives of Pediatrics & Adolescent Medicine.

Dr. Arthur J. Reynolds, professor at the Institute of Child Development, and his coauthors followed a group of 1,539 low-income children in the CPC program. Roughly 1,000 children in the study were enrolled in the CPC program at ages 3 or 4 and 500 were enrolled in the comparison group, which was made up of children in alternative early childhood education programs. Children in the CPC group were matched to children in the comparison group of similar age and background. The study began following the children in 1985 and 1986. Families moved into and out of the area during the time the study took place, so not all children completed all components of the CPC program. The children in the study were 93% African American and 7% Hispanic.

Because the study did not assign children randomly to the two groups, it cannot conclusively prove that the CPC program caused the gains observed in its graduates. However, the study results strongly suggest that the program produced lasting benefits—even for children who completed only part of the program. By age 24, for example, children who participated only in the preschool program had lower rates of depression, lower rates of violent crime and incarceration, were more likely to attend 4 year colleges and were more likely to have health insurance than children who did not participate in the preschool program. However, graduates of both the preschool and school age components of the CPC program were more likely to attend college and to be employed full time, and less likely to receive public assistance or to have a disability than those who participated in other programs. Children who participated in only the school age component of the CPC program also showed benefits in adult life. By age 24, these children had lower rates of disability and were less likely to receive public assistance.

Reynolds noted that past research has shown that completing more schooling is linked with earning a higher income, a decreased involvement in criminal activity and even a decrease in rates of depression. "Children who participated in this program had a greater recognition that more schooling is the way out of poverty," he said. "The study is the first to show that large-scale established programs run by schools can have enduring effects into adulthood across a range of outcomes."

— Source: The National Institute of Health

Adults with attention-deficit/hyperactivity disorder (ADHD) show a blunted response to the drug methylphenidate (Ritalin), which increases brain dopamine levels, according to a report in a recent issue of Archives of General Psychiatry. This suggests that dopamine dysfunction may be involved with ADHD symptoms and may contribute to substance abuse that often occurs simultaneously. “Despite decades of research, the specific neurobiological mechanisms underlying this disorder still remain unclear,” the authors write. “Genetic, clinical and imaging studies point to a disruption of the brain dopamine system, which is corroborated by the clinical effectiveness of stimulant drugs (methylphenidate hydrochloride and amphetamine), which increase extracellular dopamine in the brain.”

Nora D. Volkow, MD, of the National Institute on Drug Abuse, Bethesda, Md., and colleagues studied 19 adults with ADHD (average age of 32) who had never received medication and 24 healthy controls (average age of 30). Brain scans were performed using positron emission tomography (PET) and a drug known as raclopride labeled with carbon 11 ([11C]raclopride), which binds with dopamine receptors. Scans were performed twice, after injections of placebo and of methylphenidate; the participants did not know which drug they had received. Participants also were asked to report the severity of their ADHD symptoms, whether they could detect the drug, if they liked or disliked it, and if it made them feel “high,” tired, alert, anxious, or restless.

In individuals with ADHD, methylphenidate caused less of a decrease in the amount of [11C]raclopride that bound to dopamine receptors in areas of the brain associated with attention than it did in those without ADHD. Since levels of methylphenidate in the blood were the same in both groups, this suggests that those with ADHD released less dopamine in response to the drug than controls. This blunted response was associated with symptoms of inattention. Exploratory analyses also found evidence of reduced [11C]raclopride binding in the hippocampus and amygdala in those with ADHD. These areas of the brain are part of the limbic system, involved in emotional responses as well as consolidating and retrieving memories. “The findings of reduced dopamine release in subjects with ADHD are consistent with the notion that the ability of stimulant medications to enhance extracellular dopamine underlies their therapeutic effects in ADHD,” the authors write.

Individuals with ADHD also reported liking methylphenidate more than individuals without ADHD, the authors note. “The reinforcing responses to methylphenidate were negatively correlated with the dopamine increases, suggesting that decreased dopaminergic activity may also be involved in modulating the magnitude of the reinforcing effects of methylphenidate,” they continue. “This suggests that dopamine dysfunction is involved with symptoms of inattention but may also contribute to substance abuse comorbidity in ADHD.”

— Source: American Medical Association

DISCOVERY

To dance in the discovery
To marvel in the mystery
To connect in the conversation
To love in the listening
To sing in the service
To swim in the spirit
To create in the collaboration
Integrating the art with the science
Social Work is living life in compassionate
Action with the aim of social justice.
I Care, Therefore, I Am.

GRATITUDE

Giving Thanks
Thanks for the Giving
Upon us it is.

The Spirit of reverance for life, may
We honor and open our hearts.

The ecology of the mind, may we
Purify and protect.

Mindfulness in every breath
Peace in every step

Abundance within, may we cultivate and offer
It without

Compassion
And
Community
The deeper tenets of our Human Family

Sojourners we are on borrowed time and
Borrowed territory of Mother Earth
May the light of
Respect
Honor and
Humility
guide our way in this world
and be the tools we use to take our stand
in this land
serving our brothers and sisters, mothers and fathers,
sons and daughters...
wielding our warrior strength
through
wise discernment

knowing
that the Ultimate
of all
Powers
in Life
Is
Love.

TEAMING

I often sit
in
Silence
and see
surrounding the
self of me
many people who are clearly
gifts to the Spirit.
In the honoring of such gifts,
I do weep.

A Dream
A Vision
Of what can Be

What do we need in order to See?
Strength of Heart
Sensitivity in Spirit
Clarity of Compassion

Respect
Honor
And Humility

A holding together among all members on the Team
of the same Dream
of the same Vision
driven by a Unified Mission-
A Mission undergirded by an intimacy with the work
and a commitment to move toward
Integrity.

TEMPERED STEEL

Transformation
Born
Out of
The
Tempest
Within.

A soaring
Spirituality
Rising to new heights
Born out of
The
Daily
Discipline

A training of the mind
Meaning in the pain and suffering, both within and without,
My current search to find.

Today, I am able to See
I have many Teachers
Through written word, print
And,
In physical form, present

My Process:
One of tempering steel
My Aim: To become stronger, more compassionate and
Clear.

— Jean E. Balestrery LICSW, MAC, ACSW has 16 years experience working in the mental health and substance abuse fields of practice. Her time living and working in the bush of Alaska inspired this writing. She is currently enrolled in the dual discipline
doctoral program in social work and anthropology at the University of Michigan.

A novel, free, public online database opening this week should greatly speed efforts to find genes linked to increase risk of bipolar disorder. The Bipolar Disorder Phenome Database—a joint project of Johns Hopkins Psychiatry and the National Institute of Mental Health—is the first of its kind, offering detailed descriptions of symptoms and course of disease on more than 5,000 people with bipolar illness, a mood disorder commonly marked by alternating bouts of depression and manic or overexcited behavior. Because DNA samples also are available for this group, the database will let researchers correlate specific symptoms with sequences of genetic material. The new database is meant to complement the massive bodies of genetic data generated already by the Human Genome Project, the International HapMap Consortium and the Genetic Analysis Information Network.

“This database describes the clinical picture of bipolar disorder in the fullest detail possible,” says James Potash, MD, who led the Hopkins portion of efforts to assemble the site. “It also lets us pick out meaningful clusters of symptoms that will ultimately help identify genes.” Using this newer clinical subtyping approach to gene hunting, scientists winnow out “pure” groups of patients with a key characteristic—like those whose bipolar disorder (BD) begins earlier than usual or those who also experience panic attacks. Suspect stretches of DNA—including genes—are more likely to stand out in such groups. The approach has been effective in finding genes associated with Alzheimer’s disease and breast cancer, Potash says.

Collecting accurate descriptions of patients in large enough numbers to ensure reliable results is costly and time-consuming, he adds. The Bipolar Disorder Phenome Database lets researchers tap into information from two national studies of BD families collected over 20 years through patient surveys and interviews. The studies included patients with well-documented bipolar disorder who had first-degree relatives with a major mood illness.

— Source: Johns Hopkins Medical Institutions

A survey of adults displaced by war in northern Uganda found high rates of posttraumatic stress disorder (PTSD) and depression, and that these individuals were more likely to favor violent means to end the conflict compared to persons without these symptoms, according to a study in a recent issue of the Journal of the American Medical Association. Patrick Vinck, PhD, of the University of California, Berkeley, and colleagues assessed the level of exposure to war-related violence and the prevalence of PTSD and depression symptoms by surveying 2,585 adults in villages and camps for internally displaced persons in four districts of northern Uganda in April and May 2005. The researchers also examined if these factors are associated with respondents’ views as to whether violent or nonviolent means should be pursued to achieve peace in northern Uganda.

War in Uganda has been waged since the late 1980s by the Lord’s Resistance Army (LRA) against the Ugandan People’s Democratic Army and the people of Uganda. Numerous people have been killed or abducted and up to a million and a half people have been displaced in camps, where they live in poverty and despair, according to the article. The researchers found that about three quarters of the respondents (74.3%) met PTSD symptom criteria and almost one half (44.5%) met depression symptom criteria. Four patterns of exposure to trauma were distinguished: those with low exposure (group 1; 21.4%); witnesses to war-related violence (group 2; 17.8%); those threatened with death and/or physically injured (group 3; 16.4%); and those abducted (group 4; 44.3%). Respondents in groups 3 and 4, who experienced the most traumatic exposures, were more likely to have PTSD and depression symptoms compared with group 1. Respondents who met the PTSD symptom criteria were more likely to identify violence as a means to achieve peace. Respondents who met the depression sym