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Abstract This paper conceptualizes the act of diagnosis in primary care as a 'diagnostic moment,' comprising a diagnostic utterance in a 'diagnostic slot,' together with a patient response. Using a dataset of 201 treated conditions drawn from 255 video recorded medical visits with 71 physicians across 33 clinical practices in the Western United States, we investigate the incidence of diagnostic moments, aspects of their verbal design, and patient responsiveness. We find that only 53% of treated conditions in the dataset are associated with a diagnostic moment. Physicians present 66% of these diagnoses as hedged or otherwise doubtful, and deliver 30% of them without gazing at the patient. In the context of these diagnostic moments, patients are non- or minimally responsive 59% of the time. These findings underscore the different significance that may be accorded diagnosis in primary care in contrast to care in other medical contexts. The paper concludes that the analysis of sequences of action which empirically realize diagnosis are underrepresented in the sociology of diagnosis, and that better understanding of the diagnostic moment would enhance our understanding of diagnostic processes in primary care. Highlights • Conceptualizes Jutel (2014) 'diagnostic moment' as an interactional sequence. • First comprehensive description of the frequency of diagnoses and responses in US primary care. • Describes the main design features of diagnoses with regard to certainty and uncertainty. • Shows that patient responses to diagnoses are sensitive to these designs. [ABSTRACT FROM AUTHOR]

• Endometriosis in adolescents presents differently than adult women. • Adolescents with endometriosis are at a particular risk for pain due to diagnostic delays. • A multidimensional research method is needed: Inflammation; Nerve, Brain; Psychology. • Literature review with research suggestions for adolescents with endometriosis. Endometriosis, a condition in which uterine tissue grows outside the uterus, is a debilitating disease, affecting millions of women and costing the United States approximately $78 billion annually in pain- related disability. It is also the leading cause of chronic pelvic pain (CPP), which is often unresponsive to existing treatments. Adolescent women with the disease are at particular risk as there are often significant diagnostic delays, which in turn can exacerbate pain. Research and treatment guidelines for adolescents with endometriosis are largely based on studies for adult women due to the limited number of studies focusing on adolescents. The current paper critically reviews the literature as it pertains to endometriosis pathophysiology, mechanisms contributing to CPP, and treatment implications and recommendations with a focus on gaps related to adolescents. [ABSTRACT FROM AUTHOR]

New approaches to universal eating disorders prevention and interventions targeting macro-environmental change are greatly needed, and research-to-policy translation efforts hold promise for advancing both of these goals. This paper describes as a policy-translation case example an academic-community-government partnership of the Strategic Training Initiative for the Prevention of Eating Disorders, Multi-Service Eating Disorders Association, and the office of Massachusetts Representative Kay Khan, all based in Massachusetts, USA. The partnership's research-to-policy translation project focused on dietary supplements sold for weight loss and muscle building, which have been linked with serious injury and death in consumers. Youth and people of all ages with eating disorders and body dysmorphic disorder may be especially vulnerable to use these products due to deceptive promises of fast and safe weight loss and muscle gain. The research-to-policy translation project was informed by a triggers-to-action framework to establish the evidentiary base of harm to consumers, operationalize policy solutions to mitigate harm through legislation, and generate political will to support action through legislation introduced in the Massachusetts legislature to restrict sales of weight-loss and muscle-building dietary supplements. The paper concludes with lessons learned from this unique policy translation effort for the prevention of disordered weight and shape control behaviors and offers recommendations for next steps for the field to advance research and practice for universal, macro-environmentally targeted prevention. [ABSTRACT FROM AUTHOR]

Background: Naloxone is a prescription medication that can quickly and effectively reverse opioid overdose. Medicaid is a major payer of substance use disorder services, and Medicaid beneficiaries experience especially high rates of opioid overdose. As opioid overdose rates have risen sharply, every state has modified its laws to make naloxone easier to access. The aim of this paper is to determine whether implementation of different provisions of naloxone access laws led to increased naloxone dispensing financed by Medicaid.Methods: We reviewed naloxone legislation passed by every state between 2007 and 2016. We used the Medicaid State Drug Utilization dataset to examine the effect of different types of state naloxone access law provisions, separately and as a whole, on the number of outpatient naloxone prescriptions reimbursed by Medicaid from 2007 to 2016. We included state-level covariates in our models that may be correlated with naloxone utilization in Medicaid and passage of naloxone access laws.Results: We found that the presence of any naloxone law was significantly associated with increases in outpatient naloxone reimbursed through Medicaid. Laws containing standing order provisions were most consistently associated with increases in naloxone dispensing across models. Standing order provisions led on average to an increase of approximately 33 naloxone prescriptions per state-quarter, which is equivalent to 74% of the average number of naloxone prescriptions per state-quarter.Conclusions: Naloxone access laws, particularly those with standing order provisions, appear to be an effective policy approach to increasing naloxone access among Medicaid beneficiaries. [ABSTRACT FROM AUTHOR]

Respondents of online surveys may exhibit some answering behaviors, which lead to inconsistent survey results between online surveys and traditional paper surveys. Extant research has not yet devoted sufficient effort to the mechanisms of different answering behaviors on the inconsistent results, especially in cross-cultural survey contexts. For this reason, this study examines how shirking behavior (i.e., a form of disengaged behavior that the respondents expend insufficient mental effort on the questionnaire) and socially desirable responding result in incomparable responses between online surveys and paper surveys. We especially investigate how the cultural constructs of individualism and collectivism relate to shirking and social desirability. Our results reveal two different pathways leading to inconsistent results across different survey modes. Respondents from collectivistic cultures are more likely to shirking in online surveys. Consequently, they are more likely to provide varying responses than respondents from individualistic cultures. Collectivists are more likely to engage in impression management in paper surveys than in online surveys, while individualists have a greater tendency to provide inflated assessments of their skills and abilities in both survey modes. [ABSTRACT FROM AUTHOR]

While there have been important recent advances in the development of effective universal prevention and intervention programs, it is not yet clear how to engage large numbers of students in these programs. In this paper, we report findings from a two-phase pilot study. In the first phase, we used a population-level, online survey to assess eating disorder symptom level and habits/attitudes related to service utilization (N=2180). Using validated screening tools, we found that roughly one in three students has significant symptoms of eating disorders or elevated weight concerns, the vast majority of whom (86.5%) have not received treatment. In the second phase, we referred students to online prevention and selective/indicated intervention programs based on symptom classification (N=1916). We find that program enrollment is highest for students in the indicated intervention (18.1%) and lowest for students in the universal prevention (4.1%). We find that traditionally-emphasized barriers such as stigma, misinformation, and financial limitations do not appear to be the most important factors preventing treatment-seeking. Rather students report not seeking help for reasons such as lack of time, lack of perceived need, and a desire to deal with the issue "on my own." Findings offer insight into the treatment-seeking habits and attitudes of college students, including those barriers that may be overcome by offering online programs and those that persist despite increased access to and convenience of relevant resources. [ABSTRACT FROM AUTHOR]

Drawing on Uses and Gratifications theory, this paper proposes and empirically tests an integrated model that depicts the factors that have the potential to impact the behavioral intention to adopt online games. The model is tested with data collected from 308 students in an American university. Overall, the results revealed that the effect of enjoyment was very crucial, and those of social interaction and achievement are moderate, but that of flow of experience did not influence behavioral intention. Results also indicated that visual appeal and escapism are important factors that affect and precede enjoyment. [ABSTRACT FROM AUTHOR]

Individuals in the early stages of the behavioral variant of frontotemporal dementia (bvFTD), a progressive neurodegenerative disorder marked by atrophy to the brain's frontal regions, exhibit severe disturbances to social and moral processing and decision-making after the onset of the disorder. These behavioral impairments, underlain by the neural deficits associated with the disorder, can often lead individuals with bvFTD to criminally offend. As such, behavioral and frontotemporal lobe abnormalities exhibited by offenders with bvFTD potentially represent several complex challenges for the legal system. This paper examines some of the ways in which the behavioral and neural impairments associated with bvFTD may influence issues surrounding the criminal responsibility, specifically legal insanity, and sentencing of offenders with bvFTD in the U.S. legal system. As there is very little literature in these areas concerning bvFTD, the existing academic dialogue on psychopathy, a disorder with similar behavioral symptoms and neural deficits, is used to frame the discussion on these issues. [ABSTRACT FROM AUTHOR]

Background: Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy.Methods: Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship.Results: Only having had a previous live birth modified the termination-binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years.Conclusions: Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women - and not nulliparous women - denied terminations experienced sustained reductions in binge drinking over time. [ABSTRACT FROM AUTHOR]

Objective: This survey of published researchers of long-acting reversible contraceptives (LARCs) examines their opinions about important barriers to LARC use in the United States (US), projections for LARC use in the absence of barriers and attitudes toward incentives for clinicians to provide and women to use LARC methods.Study Design: We identified 182 authors of 59 peer-reviewed papers on LARC use published since 2013. A total of 104 completed an internet survey. We used descriptive and multivariate analyses to assess LARC use barriers and respondent characteristics associated with LARC projections and opinions.Results: The most commonly identified barrier was the cost of the device (63%), followed by women's knowledge of safety, method acceptability and expectations about use. A shortage of trained providers was a commonly cited barrier, primarily of primary care providers (49%). Median and modal projections of LARC use in the absence of these barriers were 25-29% of contracepting women. There was limited support for provider incentives and almost no support for incentives for women to use LARC methods, primarily out of concern about coercion.Conclusions: Clinical and social science LARC experts project at least a doubling of the current US rate of LARC use if barriers to method provision and adoption are removed. While LARC experts recognize the promise of LARC methods to better meet women's contraceptive needs, they anticipate that the majority of US women will not choose LARC methods. Reducing unintended pregnancy rates will depend on knowledge, availability and use of a wider range of methods of contraception to meet women's individual needs.Implications: Efforts to increase LARC use need to meet the dual goals of increasing access to LARC methods and protecting women's reproductive autonomy. To accomplish this, we need reasonable expectations for use, provider training, low-cost devices and noncoercive counseling, rather than incentives for provision or use. [ABSTRACT FROM AUTHOR]

One of the fundamental challenges in anti-doping is identifying athletes who use, or are at risk of using, prohibited performance enhancing substances. The growing trend to employ a forensic approach to doping control aims to integrate information from social sciences (e.g., psychology of doping) into organised intelligence to protect clean sport. Beyond the foreseeable consequences of a positive identification as a doping user, this task is further complicated by the discrepancy between what constitutes a doping offence in the World Anti-Doping Code and operationalized in doping research. Whilst psychology plays an important role in developing our understanding of doping behaviour in order to inform intervention and prevention, its contribution to the array of doping diagnostic tools is still in its infancy. In both research and forensic settings, we must acknowledge that (1) socially desirable responding confounds self-reported psychometric test results and (2) that the cognitive complexity surrounding test performance means that the response-time based measures and the lie detector tests for revealing concealed life-events (e.g., doping use) are prone to produce false or non-interpretable outcomes in field settings. Differences in social-cognitive characteristics of doping behaviour that are tested at group level (doping users vs. non-users) cannot be extrapolated to individuals; nor these psychometric measures used for individual diagnostics. In this paper, we present a position statement calling for policy guidance on appropriate use of psychometric assessments in the pursuit of clean sport. We argue that, to date, both self-reported and response-time based psychometric tests for doping have been designed, tested and validated to explore how athletes feel and think about doping in order to develop a better understanding of doping behaviour, not to establish evidence for doping. A false 'positive' psychological profile for doping affects not only the individual 'clean' athlete but also their entourage, their organisation and sport itself. The proposed policy guidance aims to protect the global athletic community against social, ethical and legal consequences from potential misuse of psychological tests, including erroneous or incompetent applications as forensic diagnostic tools in both practice and research. [ABSTRACT FROM AUTHOR]

Stress triggered by workplace-based interpersonal conflict can result in damaged relationships, loss of productivity, diminished job satisfaction and increasingly, workers' compensation claims for psychological injury. This paper examined the literature on the role and effectiveness of mediation, as the most common method of Alternative Dispute Resolution, in resolving workplace relationship conflict. Available evidence suggests that mediation is most effective when supported by organisational commitment to ADR strategies, policies and processes, and conducted by independent, experienced and qualified mediators. The United States Postal Service program REDRESS™ is described as an illustration of the successful use of mediation to resolve conflict in the workplace. [ABSTRACT FROM AUTHOR]

Objectives The purposes of this study were to (a) examine the prevalence of disordered eating among female figure skaters, (b) compare levels of disordered eating between skaters and their same-age peers, (c) compare levels of disordered eating between elite skaters and their sub-elite counterparts, and (d) examine general and sport-related correlates of disordered eating (i.e., four sport-related weight pressures, general and sport-related body dissatisfaction, positive and negative perfectionism, self-esteem, and athletic identity). Design This study employed a cross-sectional design. Methods Participants completed paper–pencil surveys, including measures for disordered eating, four sport-related weight pressures, general and sport-related body dissatisfaction, positive and negative perfectionism, self-esteem, and athletic identity. Participants included 272 female figure skaters ages 12–25 ( M = 15.63) across five US states. Results Thirteen percent of participants scored within range of problematic eating attitudes and behaviors but were no more symptomatic than their same-age peers when compared to existing normative data. Levels of disordered eating did not significantly differ between those competing at the elite and sub-elite level. After controlling for body mass index and age, disordered eating was significantly predicted by self-consciousness of weight and appearance, general and sport-related body dissatisfaction, and positive perfectionism. Conclusions Disordered eating occurs in female figure skaters across competitive levels. Concern over weight and appearance, dissatisfaction with one's body in general and in sport, and positive perfectionism may serve as important tools in the prevention and detection of disordered eating in female figure skaters. [ABSTRACT FROM AUTHOR]

The relationship between childhood adversity and adult depression is well-established but less is known about the association between childhood adversity and adult depression among the incarcerated. In this paper, we examine differential exposure and vulnerability to childhood adversity by race/ethnicity and gender on adult depression among the incarcerated in the United States. We address three research questions: does exposure to childhood adverse experiences vary by race/ethnicity and gender? Is there an association between these childhood adverse events and depression and does the strength of the association vary by the specific adverse experiences? And does vulnerability to childhood adversity vary by gender and race/ethnicity? Using the 2004 Survey of Inmates in State and Federal Correctional Facilities (SI-SFCF), we measure four key childhood adverse events - parental/caretaker substance abuse, physical assault, having been placed in foster care, and sexual assault. We use ordinary least squares regression and a series of interaction effect analyses to examine differential exposure and vulnerability to the four childhood adverse experiences by race/ethnicity and gender. Incarcerated women are more likely to report parental substance abuse, but all inmates/prisoners are similarly vulnerable to this experience. For the other three adverse experiences measured, we find that there are important racial/ethnic and gender differences in both exposure and vulnerability. African American men and women are more vulnerable to the effects of physical and sexual victimization than White and Hispanic men and women. Women are much more likely to be exposed to sexual victimization, but men who report this experience are significantly more depressed. Hispanic women and White men and women are more likely to report foster care, but all inmates/prisoners who report foster care experiences are significantly more depressed than other inmates/prisoners, with the exception of white men. The findings indicate that there are significant differences in exposure and vulnerability to childhood adversity by race/ethnicity and gender. We conclude that in order to effectively design and implement programs to decrease the probability that childhood adversity is a risk factor for adult depression interventions must be targeted toward specific, vulnerable groups according to race/ethnicity and gender. [ABSTRACT FROM AUTHOR]

The objective of this paper was to investigate the association between contextual social capital and immunization coverage rates. A cross-sectional, ecologic study design was used. Three different estimations of contextual social capital in American states have been used. Data on immunization coverage rates at state level comes from Centers for Disease Control and Prevention. Correlation coefficients were calculated to investigate the bivariate association between the independent variable social capital and the dependent variable 2009 A(H1N1) immunization coverage rates. A multivariate OLS regression model was used to investigate the association between contextual social capital and immunization, under control for state-level health care spending per capita, state population, population per square mile, and median age in the American States. Results show that Social capital was strongly correlated with 2009 A(H1N1) immunization acceptance among American States. In a multivariate regression analysis, the association remains strong and significant also when controlling state-level confounders. In conclusion, social capital, at least in a U.S. context, is shown to be associated with the state-level uptake of vaccination against the 2009 A(H1N1) pandemic. [ABSTRACT FROM AUTHOR]

Serious child illness and hospitalization can have a lasting negative impact on children and their families. Pediatric psychosocial care (PPC) approaches are implemented to promote child resilience within medical settings and to optimize quality of life for children affected by chronic health conditions. However, numerous opportunities remain to adopt best practices and enhance the well-being of children facing illness and hospitalization in the United States and globally. This paper situates contemporary approaches to PPC within their historical context, beginning in the early 20th century. Prominent theories that guide PPC professionals' work with hospitalized children and their families are reviewed, highlighting the practical implications of these theories for family systems-oriented practitioners working with hospitalized children. An approach to integrating theory with practice for the eclectic practitioner is illustrated using a hypothetical case study. Finally, the paper concludes with recommendations for building the evidence base for PPC through theory-driven research and quality improvement initiatives. [ABSTRACT FROM AUTHOR]