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Objective: The majority of people with gambling problems contact helplines when they are in crisis, hampering their capacity to explore suitable treatment options. To date, there has been limited research identifying the best way to support individuals to reduce distress and maximise further treatment-seeking. In this paper, we describe the development and piloting of the resulting six-step brief intervention.Method: A six-step brief intervention was developed based on a literature review of existing interventions for crisis management, semi-structured interviews with 19 participants comprising gambling and crisis support counsellors and consumers, as well as experts in the addiction field.Results: The resulting six-step brief-intervention focusses on (1) acknowledging and measuring distress; (2) normalising and reducing distress; (3) optimising motivation for change; (4) providing a sense of hope; (5) re-measuring distress and, if reduced; (6) exploring options for treatment and support.Conclusion: Whilst developed primarily for helpline counsellors, the intervention has potential application for health practitioners working across telephone, online and face-to-face services. Further research is required to determine its effectiveness in improving treatment engagement amongst people with gambling problems. [ABSTRACT FROM AUTHOR]

Background: Recent literature, largely from Africa, shows mixed effects of own-production on diet diversity. However, the role of own-production, relative to markets, in influencing food consumption becomes more pronounced as market integration increases.Objective: This paper investigates the relative importance of two factors - production diversity and household market integration - for the intake of a nutritious diet by women and households in rural India.Methods: Data analysis is based on primary data from an extensive agriculture-nutrition survey of 3600 Indian households that was collected in 2017. Dietary diversity scores are constructed for women and households is based on 24-hour and 7-day recall periods. Household market integration is measured as monthly household expenditure on key non-staple food groups. We measure production diversity in two ways - field-level and on-farm production diversity - in order to account for the cereal centric rice-wheat cropping system found in our study locations. The analysis is based on Ordinary Least Squares regressions where we control for a variety of village, household, and individual level covariates that affect food consumption, and village fixed effects. Robustness checks are done by way of using a Poisson regression specifications and 7-day recall period.Results: Conventional measures of field-level production diversity, like the number of crops or food groups grown, have no significant association with diet diversity. In contrast, it is on-farm production diversity (the field-level cultivation of pulses and on-farm livestock management, and kitchen gardens in the longer run) that is significantly associated with improved dietary diversity scores, thus suggesting the importance of non-staples in improving both individual and household dietary diversity. Furthermore, market purchases of non-staples like pulses and dairy products are associated with a significantly higher dietary diversity. Other significant determinants of dietary diversity include women's literacy and awareness of nutrition. These results mostly remain robust to changes in the recall period of the diet diversity measure and the nature of the empirical specification.Conclusions: This study contributes to the scarce empirical evidence related to diets in India. Additionally, our results indicate some key intervention areas - promoting livestock rearing, strengthening households' market integration (for purchase of non-staples) and increasing women's awareness about nutrition. These are more impactful than raising production diversity. [ABSTRACT FROM AUTHOR]

Maximum likelihood estimation techniques for subject-specific (SS) generalized linear mixed models and generalized estimating equations for marginal or population-averaged (PA) models are often used for the analysis of cluster-unit intervention trials. Although both classes of procedures account for the presence of within-cluster correlations, the interpretations of fixed effects including intervention effect parameters differ in SS and PA models. Furthermore, closed-form mathematical expressions relating SS and PA parameters from the two respective approaches are generally lacking. This paper investigates the special case of correlated Poisson responses where, for a log-linear model with normal random effects, exact relationships are available. Equivalent PA model representations of two SS models commonly used in the analysis of nested cross-sectional cluster trials with count data are derived. The mathematical results are illustrated with count data from a large non-randomized cluster trial to reduce underage drinking. Knowledge of relationships among parameters in the respective mean and covariance models is essential to understanding empirical comparisons of the two approaches. [ABSTRACT FROM AUTHOR]

This paper examines how multiple roles affect the mental health of the elderly in Japan and the United States, two countries with vastly different cultures. Hypotheses were drawn based on the cultural differences in role experiences, and these hypotheses are tested by analyzing nationally representative samples of the elderly in these countries. The results show that Americans are more likely to be involved in roles related to family, work, and community, while the Japanese are more likely to be involved in only those roles related to family and work. Multiple roles are also found to be less beneficialfor the mental health of Japanese elderly compared to American counterparts. National differences in the effects of individual roles and role configurations on mental health are also documented. Overall, the results show the importance of broad cultural contexts for understanding the relationship between roles and mental health. [ABSTRACT FROM AUTHOR]

This paper describes a series of 4 studies, designed to provide evidence of the feasibility, reliability, and validity of the Timeline Followback (TLFB) method when used to assess sexual risk behaviour with psychiatric outpatients. This population was selected because patients often have difficulty completing assessments of sexual risk behaviours due to deficits in attention, memory, and communication skills. All 4 studies demonstrated the feasibility of the HIV-risk TLFB. Study 1 also demonstrated that it can be completed in 20 min, and scored in less than 10 min. Qualitative data revealed that both patients and assessors found the features of the TLFB helpful. Study 2 provided evidence that the HIV-risk TLFB can be reliably scored by interviewers whereas Study 3 demonstrated that this measure can be completed reliably by patients and that TLFB of sexual behaviour were consistent over time. Study 4 provided initial evidence for the validity of the HIV-risk TLFB but also suggested that the TLFB may yield frequency estimates that are slightly less than those obtained with single-item measures. We conclude that the TLFB is feasible, reliable, and valid, even in a population known to have difficulty with self-report measures. [ABSTRACT FROM AUTHOR]

The objective of this paper is to evaluate a peer education programme for female sex workers in Bali, Indonesia. Sex workers participated in face-to-face interviews and STD exams in August-September 1998. In October 1998 one woman from each of 30 clusters was selected to be a peer educator and received a 2-day training on AIDS, STDs, condom use, and condom negotiation. After training, the peer educators were visited twice a week by field workers to answer questions and offer support. All sex workers received group education every 2 months. In January-February 1999, the sex workers again participated in face-to-face interviews and examinations. One month after peer education training, only 50% of the peer educators were still working in the clusters where they were trained. To evaluate the impact of the peer educators, sex workers in clusters where a peer educator continued to work were compared with sex workers in clusters where women did not continue to work (n=189). In clusters where women continued to work, there were higher levels of AIDS knowledge (P < 0.05), STD knowledge (P < 0.05) and condom use (82 vs 73%, P=0.15). The prevalence of Neisseria gonorrhoeae infection was also lower in clusters with a peer educator (39% vs 55%, P=0.05) than in clusters without a peer educator. [ABSTRACT FROM AUTHOR]

Objective: To identify and understand the linguistic expertise of psychiatrists in clinical interviews with patients experiencing thought disorder (TD).Method: Qualitative analysis of 24 routine clinical interviews between psychiatrists and inpatients with TD.Results: Psychiatrists demonstrated the expertise with which they navigated clinical interviews and accomplished shared goals with patients experiencing TD. These findings highlight the need to rethink the notion that such patients are incapable of productive communication. Capturing and describing psychiatrists' tacit expertise provides a foundation for documenting an under-recognised skill set.Conclusions: Understanding such expertise could enhance the care of patients with TD, repositioning them as active participants in the accomplishment of shared therapeutic goals. Teaching these skills to mental health clinicians during their training would improve their ability to establish effective therapeutic relationships with these patients. [ABSTRACT FROM AUTHOR]

Despite limited program evaluations of Medicaid accountable care organizations (ACOs), no studies have examined if cost-saving goals negatively affect quality of life and health care experiences of low-income enrollees. The Hennepin Health ACO uses an integrated care model to address the physical, behavioral, and social needs of Medicaid expansion enrollees. As part of a larger evaluation, we conducted semistructured interviews with 35 primary care using Hennepin Health members enrolled for 2 or more years. Using fuzzy set qualitative comparative analysis, we assessed enrollee complexity and use of the care model and improvements in quality of life. We found improved quality of life was consistently associated with strong bonds to primary care, consistent mental health care, and support from extended care team members. Comprehensive, integrated care models within ACOs may improve quality of life for low-income Medicaid enrollees through coordinated primary and mental health care. [ABSTRACT FROM AUTHOR]

Objective: This study determined the cultural appropriateness of the Structured Clinical Interview for the DSM-IV Axis I Disorders (SCID-I) as an acceptable tool for diagnosing mental illness among Indigenous people.Methods: De-identified qualitative feedback from participants and psychologists regarding the cultural appropriateness of the SCID-I for Indigenous people using open-ended anonymous questionnaires was gathered. Aboriginal Medial Service staff and Indigenous Support Workers participated in a focus group.Results: A total of 95.6% of participants felt comfortable during the 498 questionnaires completed. Psychologists also provided qualitative feedback for 502 (92.3%) interviews, of whom 40.4% established a good rapport with participants. Of the participants, 77.7% understood the SCID-I questions well, while 72.5% did not require any cultural allowances to reach a clinical diagnosis.Conclusion: When administered by a culturally safe trained psychologist, SCID-I is well tolerated in this group. [ABSTRACT FROM AUTHOR]

Individual and household-level characteristics that influence sexual behavior have been extensively studied in South Africa, but community characteristics have received limited attention. We use multilevel discrete time hazard models and multilevel logistic regression models to analyze data from a representative sample of young people in KwaZulu Natal, and from several sources of community data. Results suggest that, net of individual and household characteristics, higher levels of community concentrated disadvantage are associated with increased hazard of sexual initiation and higher risk of unprotected sex. Social disorder increases the hazard of sexual initiation, while greater community social cohesion is associated with delayed sexual debut, although the latter association appears stronger for young men than for young women. We discuss these results and the ways they vary from predictions based on US. theory in light of conditions prevailing in contemporary South Africa. [ABSTRACT FROM AUTHOR]

Using data from a 2005 national survey of working adults in the United States, we examine the effects of the gender composition of the superordinate-subordinate role-set on mental and physical health measures. Subordinates' and superordinates' genders are important determinants. Men who work in gender-mixed superordinate contexts (i.e., with one male and one female superior) report lower levels of distress and physical symptoms than men who work with one male superior. Women who work with one male superior report less distress and fewer physical symptoms compared to women who work with one female superior or in gender-mixed superordinate contexts. With a few exceptions, these observations generally hold net of occupation, job sector, and an array of work-related conditions. We discuss the implications of these findings in light of predictions derived from the similarity-attraction and role congruity theories. We also outline ways that theoretical development in relational demography can be refined by a more specific focus on the demographic characteristics--especially gender--of the superordinate-subordinate role-set. [ABSTRACT FROM AUTHOR]

Background: Deliberate self-poisoning by ingesting pesticides is a serious health problem among farmers, especially in low- and middle-income countries. Preventing these suicides is a priority for a public mental health agenda.Objective: To examine the role of pesticide poisoning in suicide and nonfatal deliberate self-harm, and clarify awareness of risks, safe practices concerning storage and use of pesticides, and associated self-injury, both unintentional and intentional, within farmer households of the Sundarban region, India.Methods: Retrospective record review of adult cases of deliberate self-poisoning at the Block Primary Health Centres of 13 Sundarban Blocks was performed to analyze the relative roles of various methods of self-harm and their lethality. Focus group discussions, questionnaires, and in-depth interviews were undertaken in a community study of farmer households to examine pesticide-related views and practices, with particular attention to storage, use, and health impact.Results: Pesticide poisoning was the most common method of deliberate self-harm in both men and women. Pesticide storage in most households was unsafe and knowledge was inadequate concerning adverse effects of pesticides on health, crops, and the environment.Conclusions: An intersectoral approach linking the interests of public health, mental health, and agriculture is well suited to serve the collective interests of all three agendas better than each in isolation. Such an approach is needed to reduce morbidity and mortality from unintentional and intentional self-injury in low-income agricultural communities like those of the Sundarban region. [ABSTRACT FROM AUTHOR]

Male and female smokers appear to differ on several factors relevant to their tobacco addiction. Additional exclusion criteria were as follows: current medication use (not including birth control), current medical or psychiatric condition, contraindication to magnetic resonance imaging, previous NRT inhaler use, and previous participation in a similar study. Since female smokers have higher base rates of comorbid psychiatric disorders relative to males ([4]), it is possible that findings from clinical and experimental studies that use such exclusion criteria are less generalizable to female smokers. [Extracted from the article]

Background: Attributes that caregivers assign to complementary foods have been primarily described in the context of illness, but attributes assigned to foods in everyday circumstances must be understood to effectively promote good complementary feeding.Objective: This study aimed to understand how mothers judge complementary foods to be appropriate by cross-cultural examination of food perceptions in four different Latin American and Caribbean countries.Methods: We used semistructured interviews to assess attributes that mothers ascribed to a list of key foods, both home-made and manufactured, and reasons for feeding or not feeding them. We elicited attributes from 79 caregivers with children 6 to 24 months of age from two urban and perirban sites each in Brazil, Jamaica, Mexico, and Panama.Results: Textual analysis based on six home foods common to the four countries and manufactured foods resulted in six attribute categories, five of which could be positive or negative (Nutrient Content, Effects on Child, Child's Response, Availability and Accessibility, and Other Food Attributes); one (Food Quality and Safety) was only negative. Analysis of attributes of home foods (chicken, eggs, beans, carrots, bananas or plantains, and oranges) revealed many beliefs that were common within and across countries, whereas analysis of the attributes of manufactured foods revealed that these foods were less known.Conclusions: The consistency of the attribute categories across countries and across home and manufactured foods suggests their relevance to planning programs to improve complementary feeding in Latin America and the Caribbean and possibly other developing countries. These results can be used programmatically to assess the need for and the focus of food education programs, and to indicate which countries will be more receptive to certain foods as a means of improving complementary feeding. [ABSTRACT FROM AUTHOR]

We examine whether racial/ethnic/language-based variation in measured levels of patients' trust in a physician depends on the survey items used to measure that trust. Survey items include: (1) a direct measure of patients' trust that the doctor will put the patient's medical needs above all other considerations, and (2) three indirect measures of trust asking about expectations for specific physician behaviors, including referring to a specialist, being influenced by insurance rules, and performing unnecessary tests. Using a national survey, we find lower scores on indirect measures of trust in a physician among minority users of health care services than among non-Hispanic white users. In contrast, the direct measure of trust does not differ among non-Hispanic whites and nonwhites once we control for potential confounding factors. The results indicate that racial/ethnic/language-based differences exist primarily in those aspects of patients' trust in a physician that reflect specific physician behaviors. [ABSTRACT FROM AUTHOR]

Are occupational and work conditions associated with work-to-home conflict? If so, do those associations vary by gender? Among a sample of adults in Toronto, Canada, we found that men and women in higher-status occupations reported higher levels of work-to-home conflict than workers in lower-status jobs. In addition, we observed higher levels of work-to-home conflict among workers who are self-employed and among those with more job authority, demands, involvement, and longer hours. The only significant gender-contingent effect was found for nonroutine work, which is associated positively with work-to-home conflict among men but not women. Higher levels of job demands, involvement, and hours among individuals in higher-status occupations significantly contribute to occupation-based differences in work-to-home conflict. Moreover, despite some overlap, these work conditions have largely independent associations with work-to-home conflict. Results generally support the "stress of higher status " hypothesis among both women and men. Although higher-status positions yield many rewards, such positions are not impervious to inter-role stress, and this stress may offset those rewards. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The regular use of ecstasy (3,4-methylenedioxymethamphetamine, MDMA) has been associated with depressed mood, anxiety and hostility, but it is not known whether such effects persist after people stop using the drug. Furthermore, little is known about what factors might influence the decision to quit using MDMA. The aim of the present study was to examine the reasons why ex-users had stopped using this drug and to assess their current levels of depression, anxiety, anger and aggression. Telephone interviews were conducted with people who used to take MDMA on a regular basis but who no longer used the drug. The participants comprised sixty-six ex-users who used to take MDMA regularly (at least once every 2 months over a period of at least 1 year), but who had not taken MDMA for at least 1 year (average 3 years). Participants were asked about why they had quit MDMA. They also completed questionnaires to assess trait mood. Ex-users could be divided into two groups based on their reason for quitting: (i) those who had quit for mental health reasons and (ii) those who had quit for circumstantial reasons. Approximately half of those in the mental health group scored in the range for clinical depression. In that group, current levels of depression and anxiety correlated significantly with the cumulative amount of MDMA that they had taken several years previously. These findings suggest that some users may either be more vulnerable to the adverse effects of MDMA or have pre-existing mental health problems for which they self-medicate by using ecstasy. The present study shows that some ex-users experience an impairment to mental health that persists for years after they stop using this drug. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the interrater reliability of the Fitness Interview Test (FIT), revised edition, a semistructured interview that assesses fitness to stand trial.Method: Physicians, forensic psychologists, nurses, and graduate students in psychology were trained in the FIT, and they subsequently viewed 2 videotaped interviews of actual fitness assessments. Using the FIT, they rated the fitness of each defendant portrayed in the videotapes.Results: For overall judgment of fitness, the average intraclass correlation based on the full samples of raters was found to be 0.98, and for most items on the FIT, intraclass correlations fell within the 0.80 s and 0.90 s. Reliability estimates were high across professional groups.Conclusions: Overall, this study provides further support for the psychometric properties of the FIT, as well as for the ability of various professionals to conduct reliable fitness assessments using the FIT. [ABSTRACT FROM AUTHOR]

To investigate learning in telemedicine, qualitative interviews were conducted with 30 people working with telepsychiatry, teledermatology, a telepathology frozen-section service and tele-otolaryngology. More than 80% of the respondents said that they had learnt something new by using telemedicine. Most frequently the participants improved their knowledge of the specialty in which they were involved, but this was not the only way in which they learnt. The learning did not necessarily change behaviour, as two-thirds of the respondents felt that the learning had not permitted them to perform tasks for which they had previously needed assistance (although this varied somewhat with the type of telemedical work that respondents were engaged in). Two-thirds of respondents thought that something more could be done in telemedical work to promote their own learning, which shows the clear potential for learning by telemedicine. Learning could be promoted further by extending the use of the technology to other applications. To start working with telemedicine, initial instruction seems to be sufficient--a more extensive training programme appears unnecessary. In future, as many applications of telemedicine are implemented, health-care organizations may become important arenas for learning and leaders will have to focus on learning. The results of the present study clearly showed that working with telemedicine produces learning. [ABSTRACT FROM AUTHOR]

During June and July 1999, oral interviews were conducted on 666 women seeking prenatal care at 9 medical facilities in Chennai and Mysore, India, to assess their attitudes towards prenatal HIV testing and antiretroviral prophylaxis for preventing perinatal HIV transmission if needed. Seventy-eight per cent were aware of the risk of perinatal HIV transmission and 36% knew that intervention could reduce the chances of such transmission. Eighty-six per cent would agree to undergo prenatal HIV testing but only 21% of all respondents would make this decision independently while 46% said their husband would have to decide. Of those women who would not agree to testing, 21% would agree if testing were compulsory. Ninety-seven per cent of respondents would undergo antiretroviral prophylaxis to prevent vertical transmission, and 94% would consider alternatives to breastfeeding if HIV positive. Considering its widespread acceptability, prenatal voluntary counselling and testing may be an affordable method of HIV prevention for this population. [ABSTRACT FROM AUTHOR]

Data on HIV/AIDS, other STDs, and related sexual practices and AIDS prevention measures in São Luís, capital of Maranhão state, were collected in May-July 1995 using participant-observation fieldwork, including a number of face-to-face interviews in addition to archival research, and were updated by correspondence in 1996-1997 and a brief visit in February 1998. In contrast to the continuing severe AIDS epidemic in southern Brazil, public health statistics and public HIV testing recently instituted in São Luís suggest that HIV infection has remained largely concentrated among men who have sex with men, as well as a few, though growing number of cases of women evidently infected by such men. However, other STDs are endemic to the region, and could provide an increasing portal of entry for HIV infection. AIDS prevention education programmes have commenced in public schools and elsewhere in São Luís, but greater emphasis needs to also be placed on the prevention and treatment of other STDs. As in other regions of Brazil and Latin America, the reportedly common practice of anal sex among heterosexuals also represents a significant yet typically underemphasized risk factor for HIV. [ABSTRACT FROM AUTHOR]

Objective: To examine demographic and clinical determinants of seeking help for mental or emotional problems. To determine the proportion of those people with a disorder who sought help. To determine what categories of professionals are sought by those who get care.Method: A 2-stage random sample of 3956 adult residents of Edmonton, Alberta, Canada was interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS) (73% completion rate). An average of 2.8 years later, a systematic random sample of 1964 subjects was reinterviewed (an 86% completion rate) using the DIS and a health care utilization questionnaire. After adjusting for age and sex, the reinterview sample was representative of those with and without a diagnosis at the first interview.Results: Of the 1964 subjects, 570 (31%) met criteria for a DIS/DSM-III diagnosis in the year preceding the interview (one-year prevalence rate). These diagnoses included generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). For those with a diagnosis, sex, age, marital status, education, employment, and income were examined as determinants of help-seeking. Only sex (female) and age (under 45) were significant predictors. Comorbidity was highly significant: the help-seeking rate for those with one diagnosis was 20.3%; for those with more than one diagnosis, the rate was 42.8% (OR = 2.94, chi 2 = 31.4, df = 1, P < 0.001). Just over 28% of those with a diagnosis saw any health care professional, and 7.7% of those without a diagnosis sought help for a mental or emotional problem. A specific diagnosis made a difference: 46.7% of those with a major depressive episode sought help, but only 16.0% of those with alcohol abuse or dependence sought care.Conclusion: Major determinants of help-seeking are sex (female), age (under 45), severity of the illness, and comorbidity. A surprisingly high proportion of those with a disorder (72%) do not seek help, and over one-third of those seeking help do not have a current DIS/DSM-III disorder. [ABSTRACT FROM AUTHOR]