Epidemiology of nonfatal deliberate self-harm in the United States as described in three medical databases

The absence of validated U.S. rates of nonfatal suicidal behavior places risk management and injury prevention programs at danger of being poorly informed and inadequately conceptualized. In this study we compare estimated rates of intentional self-harm from two ongoing surveys (National Electronic Injury Surveillance System-All Injury Program-NEISS-AIP; National Hospital Ambulatory Medical Care Survey-NHAMCS) to data from the Toxic Exposure Surveillance System. Results suggest that, for every 2002-2003 suicide, there were 12 (NEISSAIP) or 15 (NHAMCS) self-harm-related emergency department visits, and for every intentional self-poisoning death there were 33 intentional overdoses reported to poison control centers, of which two ultimately went untreated.     

Factor Structure of the Center for Epidemiological Studies Depression Scale in Hong Kong Adolescents

E. A. Southwell &; M. Merbaum (Eds.). Personality: Readings in Theory and Research. (2nd ed.) Belmont, Calif.: Brooks/Cole, 1971, 422 pages. Reviewed by Benjamin Beit-Hallahmi     

A Brief Parenting Intervention to Enhance the Parent–Child Relationship in Hong Kong: Harmony@Home

There is a dearth of high-level evidence for brief programs designed to promote positive parent–child relationships in nonwestern cultures. We present a pilot randomized controlled trial of a four-session intervention to enhance the parenting skills that promote a positive relationship with pre-adolescent children in Hong Kong. Our intervention, Harmony@Home, utilized Cunningham’s culturally appropriate coping modeling, problem-solving approach to change parental behavior. Our objective was to evaluate the feasibility, acceptability and initial evidence of benefit of the intervention. We blindly randomized 150 Hong Kong parents of children 10–13 years of age to (a) a Harmony@Home intervention group, (b) a waitlist control group, or (c) a third active intervention which shared the control group. Immediately following the intervention, we report increases in satisfaction with the parent–child relationship, one of the targeted parenting behaviors and family harmony, for the Harmony@Home group versus control group. However, only the results from satisfaction with the parent–child relationship were significant at 3-months post intervention. Most respondents reported high levels of program satisfaction. The results provide preliminary evidence that this parenting intervention is culturally acceptable for a nonwestern general population, is feasible for implementation in a community setting and shows evidence of benefit. This intervention is concordant with public health priorities because of the global importance of the parent–child relationship as a protective factor for adolescent outcomes, the need for culturally-appropriate interventions for nonwestern populations, and design characteristics that promote dissemination.     

Medical tourism in india: perceptions of physicians in tertiary care hospitals

Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy.     

Does the Chinese construct of guan export to the West?

This study reverses the usual process of assessing universality by examining whether a construct originating in non‐western cultures has functional relevance in the West. The construct of guan or “training” was proposed by Chao (1994) as reflecting important Chinese parenting practices also shared by other Confucian cultures. She proposed that this construct is more relevant to the understanding of outcomes among Asian‐American youth than constructs that have been developed in the West, such as “authoritative” parenting. The association among the behaviours incorporated in this construct and other “universal” parenting styles such as parental warmth has not been previously reported. Nor has there been a previous report of the prevalence and perceived desirability of guan behaviours from Western individuals. Participants in the present study were US (N = 118), Hong Kong (N = 171) and Pakistani (N = 98) nursing students. In all three cultures, guan items had adequate internal consistency (Cronbach's alphas ranging from .69 to .76), associated positively with parental warmth (Pearsons' r ranging from .37 to .52), and were seen as attributes of ideal parents. Mothers in all three cultures were perceived as showing more guan than fathers show. The associations between parental guan and the outcomes of perceived health, relationship harmony and life satisfaction were significant for the Asian participants. Tests of guan's functional relevance in the West had equivocal results with weak associations to positive outcomes in the West compared to Asia. However, the differences between cultures did not reach statistical significance. When the cultures were merged, parental training perceptions predicted a significant proportion of the variance in outcomes. Mothers' guan predicted self‐esteem in their children, whereas fathers' guan predicted life satisfaction. Although guan may have emerged from a Chinese cultural context, it appears to function similarly in many cultural systems, and may represent the Asian face of authoritative parenting.     

Water quality, agricultural policy and science

This paper analyses how agricultural policy and science deal with the problem of increasing exploitation of low quality irrigation water and consequent deterioration of water quality in the States of Punjab and Haryana in India. In these cereal growing tracts the policy objective of food security is translated into production technologies, price protection and subsidies. Deterioration of water quality is countered with technocentric solutions. The paper argues that the response of science to the complexities involved in natural resource problems or in the scientific understanding of farmers partial response to technological solutions recommended to improve degraded resources, is due to the existing “administrative rationalism” of natural resource bureaucracies. This administrative rationalism, “the problem-solving discourse which emphasizes the role of the expert rather than the citizen” allows policy and science to maintain their hierarchy in determining policy goals and technological solutions with scant ecological or democratic concerns. Sustainable use of water demands institutional reform in agricultural policy and the agricultural sciences. With an inter-disciplinary training in the agricultural sciences and economics, her publications address the history of and institutional reform in agricultural science, the evaluation of agricultural research, and the organization and measurement of agricultural research effort. This paper is based on an in-house project on “Ex-post evaluation of soil science technologies,” conducted during 1997–2001, in collaboration with Sunita Sangar (then QHS Fellow, NISTADS) whose Ph.D. thesis on the same topic has been submitted to IIT, Delhi in January 2002. Sunita Sangar has a degree in the life sciences, and is interested in science and technology policy issues related to soil and water resources. The authors are currently working on the NATP sponsored project, on an ecological economics framework for the evaluation of soil science research in India.     

Targeting Insight in First Episode Psychosis: A Case Study of Metacognitive Reflection Insight Therapy (MERIT)

One aspect of schizophrenia contributing to its complexity is the lack of insight individuals often have into their illness. While poor insight is prevalent throughout the course of the illness, more severe levels are associated with first-episode psychosis (FEP). Interventions addressing insight are necessary but current treatments have been shown to have limited effectiveness. Thus, a novel intervention, Metacognitive Reflection and Insight Therapy (MERIT), is being studied for its efficacy of improving insight in individuals with schizophrenia spectrum disorders. MERIT is an integrative metacognitive therapy consisting of eight elements to assist clients in improving their ability to form complex ideas about themselves and others and to use this knowledge to respond to psychological problems. The present study is a case illustration of the implementation of MERIT to improve insight in FEP. Clinical outcomes were assessed and results showed that the client improved in both metacognition and insight. With replication, these results suggest that integrative metacognitive psychotherapy may serve as an intervention that improves insight in FEP, which marks an important step toward improved interventions for individuals with psychosis.     

Adolescent Brain Development and the Risk for Alcohol and Other Drug Problems

Dynamic changes in neurochemistry, fiber architecture, and tissue composition occur in the adolescent brain. The course of these maturational processes is being charted with greater specificity, owing to advances in neuroimaging and indicate grey matter volume reductions and protracted development of white matter in regions known to support complex cognition and behavior. Though fronto-subcortical circuitry development is notable during adolescence, asynchronous maturation of prefrontal and limbic systems may render youth more vulnerable to risky behaviors such as substance use. Indeed, binge-pattern alcohol consumption and comorbid marijuana use are common among adolescents, and are associated with neural consequences. This review summarizes the unique characteristics of adolescent brain development, particularly aspects that predispose individuals to reward seeking and risky choices during this phase of life, and discusses the influence of substance use on neuromaturation. Together, findings in this arena underscore the importance of refined research and programming efforts in adolescent health and interventional needs.     

Risk factors associated with suicide attempts and other self-injury among Hong Kong adolescents

This study examined 1,361 Chinese adolescents who reported self-injurious behaviors. Groups A and B both acknowledged deliberate self-injury, but only Group A had made a suicide attempt. Group C reported accidental self-injury. Deliberate self-injurers (Groups A and B) were more frequently girls, older, and with more suicidal ideation. Group A had more psychopathology, environmental and suicide-related risk factors than group B and C. Group C had higher depressive symptoms than noninjured controls. The study clarifies differences among self-injurious behavior groups based on expressed deliberate self-injury and self-reported suicide attempt. These three groups appear to present a continuum of risk.