The doctor-patient relationship in the post-managed care era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a "post-managed care era," where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

CBT intensity and outcome for panic disorder in a primary care setting

A hybrid efficacy-effectiveness design in which participants (n = 91/93) were retained in the study regardless of whether or not they received treatment enabled evaluation of CBT intensity in relation to panic disorder in the primary care setting. CBT intensity was operationalized as number of cognitive-behavioral therapy sessions, number of follow-up booster phone calls, and secondarily, as number of cognitive behavioral coping and exposure strategies. Baseline psychosocial and demographic predictors of CBT intensity were analyzed first. Severity of anxiety sensitivity predicted number of cognitive behavioral sessions, but no baseline variables predicted number of follow-up booster phone calls or number of coping and exposure strategies. Multivariate logistic and linear regressions were used to evaluate the degree to which treatment intensity predicted 3-month and 12-month outcomes (anxiety sensitivity, phobic avoidance, depressive symptoms, disability, and medical and mental health functioning) after controlling for potential confounding baseline variables. Number of cognitive behavioral therapy sessions predicted lower anxiety sensitivity at 3 and 12 months, and number of follow-up booster phone calls predicted lower anxiety sensitivity, less phobic avoidance, and less depression at 12 months. These findings indicate that "dose" of psychotherapy was an important predictor of outcome. The significance of follow-up booster phone contact is discussed as an index of continued self-management of panic and anxiety following acute treatment.     

Parents' and teachers' concordance with children's self-ratings of suicidality: findings from a high-risk sample

This study examined concordance between adult and child reports of child suicidality using a sample of 1,046 8-year-old children at risk for, or having experienced, maltreatment. Concordance was low with both caregivers and teachers. For children reporting no suicidality, caregiver-child agreement was associated with few transitions in caregiver and low social withdrawal and aggression, and teacher-child agreement was associated with non-White ethnicity, good academic performance, and low thought problems. For children reporting suicidality, care-giver-child agreement was associated with perceptions of child mental health needs, aggression, and somatic complaints, and teacher-child agreement was associated with thought problems.     

Outcome of patients rehabilitated through a New Zealand forensic psychiatry service: A 7.5 year retrospective study

This paper describes a 7.5 year retrospective study of all patients discharged from inpatient forensic services to forensic community team (FCT) follow-up from the Auckland Regional Forensic Psychiatry Service. Patients' files were studied for clinical, criminal, and risk data, type of service delivered, and final level of function achieved in the community. Rearrest, re-hospitalization, and reimprisonment data were obtained from clinical, court, and prison records.105 patients were included. The most common diagnosis was a psychotic disorder, and index offending behaviour was typically violent. The median period of inpatient stay was 36 months and mean subsequent FCT follow-up 21.7 months (SD 17.8). The majority of patients were from Maori and Pacific Island ethnic groups. At the end of the study, half were in independent living, half were in some form of employment, and 19% were readmitted to a forensic hospital.One patient was rearrested but not reimprisoned whilst under forensic community team care. However, 9 of the 48 who were discharged to general mental health services were rearrested and 5 reimprisoned. Only two offences were as serious as the original index offence.Broad based assertive, mandated, and committed forensic rehabilitation can achieve high quality outcomes. These levels of function may not be sustained under less assertive care.     

Training to use voice onset time as a cue to talker identification induces a left-ear/right-hemisphere processing advantage

We examined the effect of perceptual training on a well-established hemispheric asymmetry in speech processing. Eighteen listeners were trained to use a within-category difference in voice onset time (VOT) to cue talker identity. Successful learners (n=8) showed faster response times for stimuli presented only to the left ear than for those presented only to the right. The development of a left-ear/right-hemisphere advantage for processing a prototypically phonetic cue supports a model of speech perception in which lateralization is driven by functional demands (talker identification vs. phonetic categorization) rather than by acoustic stimulus properties alone.     

Previewing the neighborhood: the role of orthographic neighbors as parafoveal previews in reading

In 2 experiments, a boundary technique was used with parafoveal previews that were identical to a target (e.g., sleet), a word orthographic neighbor (sweet), or an orthographically matched nonword (speet). In Experiment 1, low-frequency words in orthographic pairs were targets, and high-frequency words were previews. In Experiment 2, the roles were reversed. In Experiment 1, neighbor words provided as much preview benefit as identical words and greater benefit than nonwords, whereas in Experiment 2, neighbor words provided no greater preview benefit than nonwords. These results indicate that the frequency of a preview influences the extraction of letter information without setting up appreciable competition between previews and targets. This is consistent with a model of word recognition in which early stages largely depend on excitation of letter information, and competition between lexical candidates becomes important only in later stages.     

The effect of word frequency, word predictability, and font difficulty on the eye movements of young and older readers

Young adult and older readers' eye movements were recorded as they read sentences containing target words that varied in frequency or predictability. In addition, half of the sentences were printed in a font that was easy to read (Times New Roman) and the other half were printed in a font that was more difficult to read (Old English). Word frequency, word predictability, and font difficulty effects were apparent in the eye movement data of both groups of readers. In the fixation time data, the pattern of results was the same, but the older readers had larger frequency and predictability effects than the younger readers. The older readers skipped words more often than the younger readers (as indicated by their skipping rate on selected target words), but they made more regressions back to the target words and more regressions overall. The E-Z Reader model was used as a platform to evaluate the results, and simulations using the model suggest that lexical processing is slowed in older readers and that, possibly as a result of this, they adopt a more risky reading strategy.     

Reduction of the misinformation effect by arousal induced after learning

Misinformation introduced after events have already occurred causes errors in later retrieval. Based on literature showing that arousal induced after learning enhances delayed retrieval, we investigated whether post-learning arousal can reduce the misinformation effect. 251 participants viewed four short film clips, each followed by a retention test, which for some participants included misinformation. Afterward, participants viewed another film clip that was either arousing or neutral. One week later, the arousal group recognized significantly more veridical details and endorsed significantly fewer misinformation items than the neutral group. The findings suggest that arousal induced after learning reduced source confusion, allowing participants to better retrieve accurate details and to better reject misinformation.     

Religiosity, self-control, and virginity status in college students from the “Bible Belt”: a research note

Using a sample of college students (N = 904) from the "Bible Belt," this study examines the effect of religiosity and self-control on late adolescents' delay in initiating sexual intercourse or oral sex. Findings from logistic regressions provide evidence that for each one unit increase in self-control, the odds of a male remaining a virgin or of delaying oral sex increased by a factor of 1.82 and 2.84, respectively, while for females, the odds of not engaging in oral sex increased by a factor of 1.67. In addition to the effect of self-control, a one unit increase in religiosity results in the odds of a male remaining a virgin by a factor of 3.86 and 3.30, respectively. For females the odds are increased by a factor of 4.13 and 2.60, respectively. Mediation tests also provided evidence that self-control mediated the effects by religiosity on both dependent measures. Thus, both religiosity and self-control independently and additively function as key social control mechanisms that promote late adolescent health.     

Children’s eyewitness memory: A comparison of two interviewing strategies as realized by forensic professionals

A critical issue for developmental psychology is how to obtain accurate and complete eyewitness memory reports from preschoolers without offering suggestions that might result in false allegations. We examined effects of two interviewing strategies (police/verbal interviews and clinician/prop-assisted interviews) on young children’s reports about a medical examination. A total of 58 4-year-olds participated in the study, which conformed to a 2 (Interview Type) × 2 (Number of Interviews) factorial design. Analyses revealed that interviewers spent less time off topic and asked more free recall questions in the police/verbal interviews than in the clinician/prop-assisted interviews. Compared with police/verbal interviews, clinician/prop-assisted interviews resulted in significantly more correct rejections and commission errors in children’s memory reports. However, on a final free recall test, error rates were comparable across conditions. Higher child verbal intelligence predicted memory accuracy in police/verbal interviews, and greater parental attachment anxiety predicted children being asked a higher number of misleading questions. The study provides new insights into interview techniques that promote preschoolers’ accurate eyewitness reports.