Variations in physician practice and covert rationing

The use of recent research on variations in medical practice to promote competitive market oriented cost containment strategies is critically examined. Research demonstrating widespread variations in physician practices for similar patient populations undermines the medical profession's claims about the scientific objectivity of medical practice and indicates the existence of widespread waste and inappropriate utilization of health care resources. Cost containment programs which rely on market-based care avoidance incentives, such as Medicare prospective payment or cost sharing plans, attempt to impact medical practice variations by creating economic barriers between doctor and patient. An alternative interpretation of research on practice variations is presented, emphasizing containing costs while improving quality of care and achieving greater equity through planning and regulation of medical supply factors.     

Suicide acceptability is related to suicide planning in U.S. adolescents and young adults

The association between adolescents' and young adults' attitudes toward suicide and their own suicidality across five racial-ethnic classifications was studied in a nationally representative sample of 3,301 youth ages 14 to 22 years from the National Annenberg Risk Survey of Youth. Results indicate that adolescents and young adults who most strongly believe that it is acceptable to end one's life are more than fourteen times more likely to make a plan to kill themselves as those who do not have such beliefs (p < .001). Future behavioral prevention and intervention research should take into consideration adolescents' and young adults' approval of suicide as a risk factor for taking their own lives.     

What's wrong with cross-cultural comparisons of subjective Likert scales?: The reference-group effect

Social comparison theory maintains that people think about themselves compared with similar others. Those in one culture, then, compare themselves with different others and standards than do those in another culture, thus potentially confounding cross-cultural comparisons. A pilot study and Study 1 demonstrated the problematic nature of this reference-group effect: Whereas cultural experts agreed that East Asians are more collectivistic than North Americans, cross-cultural comparisons of trait and attitude measures failed to reveal such a pattern. Study 2 found that manipulating reference groups enhanced the expected cultural differences, and Study 3 revealed that people from different cultural backgrounds within the same country exhibited larger differences than did people from different countries. Cross-cultural comparisons using subjective Likert scales are compromised because of different reference groups. Possible solutions are discussed.     

Amygdala oscillations and the consolidation of emotional memories

The amygdala receives multi-modal sensory inputs and projects to virtually all levels of the central nervous system. Via these widespread projections, the amygdala facilitates consolidation of emotionally arousing memories. How the amygdala promotes synaptic plasticity elsewhere in the brain remains unknown, however. Recent work indicates that amygdala neurons show theta activity during emotional arousal, and various types of oscillations during sleep. These synchronized neuronal events could promote synaptic plasticity by facilitating interactions between neocortical storage sites and temporal lobe structures involved in declarative memory.     

Attentional asymmetries in a visual orienting task are related to temperament

Spatial asymmetries are an intriguing feature of directed attention. Recent observations indicate an influence of temperament upon the direction of these asymmetries. It is unknown whether this influence generalises to visual orienting behaviour. The aim of the current study was therefore to explore the relationship between temperament and measures of spatial orienting as a function of target hemifield. An exogenous cueing task was administered to 92 healthy participants. Temperament was assessed using Carver and White's (1994) Behavioural Inhibition System and Behavioural Activation System (BIS/BAS) scales. Individuals with high sensitivity to punishment and low sensitivity to reward showed a leftward asymmetry of directed attention when there was no informative spatial cue provided. This asymmetry was not present when targets were preceded by spatial cues that were either valid or invalid. The findings support the notion that individual variations in temperament influence spatial asymmetries in visual orienting, but only when lateral targets are preceded by a non-directional (neutral) cue. The results are discussed in terms of hemispheric asymmetries and dopamine activity.     

Measuring Mental Wellbeing Among Adolescents: A Systematic Review of Instruments

Globally, promoting mental wellbeing among adolescents is of great public health and social significance. However, less is known about advances in measures of mental wellbeing, relevant for use in mental health interventions, which are age-appropriate and acceptable for use among adolescents. Comprehensive assessment includes multiple aspects of mental wellbeing, as well as positive indicators of feeling and functioning. This review used systematic review methods, guided by PRISMA, to identify and assess comprehensive instruments in terms of their content, conceptual relevance for youth, and responsiveness to change. Ryan and Deci’s framework for mental wellbeing, grounded in hedonic and eudaimonic perspectives, was applied to assess the preponderance of feeling and functioning items for each instrument. The review identified 11 instruments that fit specified inclusion criteria. Only four of the scales were developed for adolescents. Though the scales varied in their preponderance of items, all scales encompassed at least one indicator of both feeling and functioning. Findings emphasize the importance of validating adult-developed instruments for youth and ensuring the instrument’s cultural and conceptual relevance within groups of adolescents. As promoting mental wellbeing becomes critical to the field of practice, practitioners need access to relevant and acceptable measures.     

Psychometric Properties of the Beck Depression Inventory–II in Low-Income,African American Suicide Attempters

The construct of perfectionistic cognitions is defined as a state-like construct resulting from a perfectionistic self-schema and activated by specific situational demands. Only a few studies have investigated whether and how perfectionistic cognitions change across different situations and whether they reflect stable between-person differences or also within-person variations over time. We conducted 2 studies to investigate the variability and stability of 3 dimensions of perfectionistic cognitions while situational demands changed (Study 1) and on a daily level during a highly demanding period of time (Study 2). The results of both studies revealed that stable between-person differences accounted for the largest proportion of variance in the dimensions of perfectionistic cognitions and that these differences were validly associated with between-person differences in affect. The frequency of perfectionistic cognitions increased during students' first semester at university, and these average within-person changes were different for the 3 dimensions of perfectionistic cognitions (Study 1). In addition, there were between-person differences in the within-person changes that were validly associated with concurrent changes in closely related constructs (unpleasant mood and tense arousal). Within-person variations in perfectionistic cognitions were also validly associated with variations in unpleasant mood and tense arousal from day to day (Study 2).