Are Americans Getting Sicker or Healthier?

The rising cost of healthcare causes many injustices, and is not sustainable. Cost inflation is partly caused by the nature of medicine. When doctors save lives, the lives we save are usually people with chronic illnesses. Decreases in the mortality rate often lead to increases in the prevalence rate of chronic diseases and duration of chronic diseases, which are expensive to treat. As a result of advances in medical sciences, more and more people live with chronic illnesses, and therefore healthcare costs are rising. This is consistent with the conclusion that the more money a society like the USA spends on medical care, the more expensive medical care becomes. This is the dark side of medicine, which counterbalances the well-known breakthroughs of medical science. Spiritual people seek a balanced view of health that includes both viewpoints. Jeffrey Boyd, MD MPH MDiv, is Chairman of the Department of Behavioral Health at Waterbury Hospital in Waterbury CT. He is the author of Being Sick Well: Joyful Living Despite Chronic Illness (reviewed in this journal 45:1)     

Perinatal Bereavement Grief Scale: distinguishing grief from depression following miscarriage

The study evaluated the Perinatal Bereavement Grief Scale (PBGS), the first scale designed to measure grieffollowing reproductive loss in terms of yearning for the lost pregnancy and lost baby. Participants included 304 women interviewed by telephone I to 3 times within 6 months aftermiscarriage. The PBGS had high internal consistency and test-retest reliability. It showed convergent validity with measures of attachment and investment in the child and divergent validity against measures of social desirability and depressive symptoms, supporting the conceptual distinction between grief and depression. Cross-cultural validity was acceptable whether tested by language (Spanish vs. English) or ethnicity (Hispanic vs. other). This measure of yearning enables study of the epidemiology and prognostic value of this key feature of mourning.     

Primary process and peer consultation: an experiential model to work through countertransference

Various models exist for peer supervision and consultation of group therapy. This article documents the authors' experience using an experiential group consultation of group therapy model that relies on primary process to overcome countertransference dilemmas. A review of group therapy supervision and consultation models is followed by vignettes from the authors' experience. Discussion of the vignettes highlight critical issues in group consultation and expound upon the strengths and challenges of using an experiential model.     

Predicting the subjective experience of intrinsic motivation: the roles of self-determination, the balance of challenges and skills, and self-realization values

A series of studies was conducted to investigate the contributions of self-determination, perceived competence, and self-realization values to the subjective experience of intrinsic motivation. Using varying sets of instructions in these studies, college undergraduates generated and subsequently evaluated panels of identity-related activities. Three measures of the subjective experience of intrinsic motivation were used as outcome variables: (a) interest, (b) flow experiences, and (c) feelings of personal expressiveness. These subjective experience measures were strongly intercorrelated. Across studies, self-determination was found to be strongly associated with all of the subjective experience measures. In contrast, self-realization values made larger contributions to flow experiences and to personal expressiveness than to interest. Perceived competence, although significantly correlated with all subjective experience measures, played a considerably smaller role in the prediction of intrinsic motivation.     

Emotional and behavioral impact of exposure to community violence in inner-city adolescents

Used multiple methods and measures (i.e., youth report, psychiatric interviews, psychophysiological assessment) to investigate the emotional and behavioral impacts of exposure to community violence. Participants were 185 inner-city high school students (M age = 15.4 years; 42% female; 90% African American). Youth with high levels of community violence exposure reported more fears, anxiety, internalizing behavior, and negative life experiences than those with low exposure. No depression or externalizing behavior differences were observed. In a psychophysiological assessment in which adolescents watched a montage of media violence, youth exposed to high levels of community violence had lower baseline heart rates than those with low exposure. There were no between-group differences in physiologic reactivity. Regression analyses revealed that community violence exposure predicted posttraumatic stress and separation anxiety symptoms. The results suggest a significant link between community violence exposure and anxiety symptomatology. Clinical implications are discussed.     

Keeping Up with the Joneses: Friends’ Perfectionism and Students’ Orientation Toward Extrinsic Aspirations

Kasser and Ryan (1993,1996) have contrasted two types of life values: intrinsic aspirations, which include community contribution, building close relationships, and self‐growth, and extrinsic aspirations, which include fame, wealth, and physical beauty. Prioritization of extrinsic relative to intrinsic aspirations has been related cross‐sectionally to decreased well‐being (Kasser, 2002). However, the influence of close others in the etiology of young adults' prioritization of extrinsic aspirations, and the prospective effects of aspirations on well‐being, are not well understood. In a multiple‐informant prospective study of 341 university students (mean age = 19.4; 64% Caucasian; 74% female), we examined the influence of friends’ and family members’ perfectionism on participants’ aspirations, and the outcomes of prioritization of extrinsic aspirations. Having friends high in other‐oriented perfectionism was significantly positively related to prioritization of extrinsic over intrinsic aspirations. Furthermore, living with friends amplified the effect. Last, prioritization of extrinsic aspirations at T1 was related to decreased subjective well‐being and self‐concordance for goals 3 months later. The study provides preliminary evidence for a relationship between friends’ other‐oriented perfectionism and students’ orientation toward extrinsic aspirations, as well as negative prospective consequences of students’ orientation to extrinsic aspirations.     

A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics

Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.’s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled “communication.” There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC—however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.     

Temporal integration in face perception: evidence of configural processing of temporally separated face parts

Temporal integration is the process by which temporally separated visual components are combined into a unified representation. Although this process has been studied in object recognition, little is known about temporal integration in face perception and recognition. In the present study, the authors investigated the characteristics and time boundaries of facial temporal integration. Whole faces of nonfamous and famous people were segmented horizontally into 3 parts and presented in sequence, with varying interval lengths between parts. Inversion and misalignment effects were found at short intervals (0-200 ms). Moreover, their magnitude was comparable to those found with whole-face presentations. These effects were eliminated, or substantially reduced, when the delay interval was 700 ms. Order of parts presentation did not influence the pattern of inversion effects obtained within each temporal delay condition. These results demonstrate that temporal integration of faces occurs in a temporary and limited visual buffer. Moreover, they indicate that only integrated faces can undergo configural processing.