Michael W. Brand

Children of deployed National Guard troops: Perceptions of parental deployment to Operation Iraqi Freedom.

FULL DISCLOSURE POLICY In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears at the beginning of each CME-accredited article in this issue.

Implications of Public Understanding of Avian Influenza for Fostering Effective Risk Communication

Avian influenza has three of the four properties necessary to cause a pandemic. However, are we as individuals and communities prepared for a pandemic flu in the United States? To help answer this question, 12 focus groups (N = 60) were conducted in Tulsa, Oklahoma, to determine the level of awareness of avian and pandemic flu for the county health department to develop effective communication messages. The overall findings indicate that the general Tulsa public lacks information about avian influenza or pandemics, does not believe a pandemic will occur, and believes if one does occur the government will take care of it. Finally, the groups agreed that education would be the key to preventing widespread panic if a pandemic occurred. Five themes emerged: confusion about terminology, seriousness of avian influenza, disaster fatigue, appropriate precautions, and credibility of health information. Each should be considered in developing effective risk communication messages.

Family Communication Across the Military Deployment Experience: Child and Spouse Report of Communication Frequency and Quality and Associated Emotions, Behaviors, and Reactions

Frequency and quality of family deployment communication was assessed and examined in conjunction with emotions and behaviors reported by military children and spouses (N = 26) before, during, and after deployment. Child deployment communication with siblings was associated with positive child outcomes. Conversely, before and during deployment child communication with a deployed parent was related to more child emotional reactions and behavioral problems. For spouses, more and better communication with children and the deployed partner was related to the spouses having less negative temper or stress reactions. Use of newer communication technology during deployment was related to negative child outcomes.

Anger types and the use of cigarettes and smokeless tobacco among Native American adolescents.

BACKGROUND Although tobacco use appears common among Native Americans, the study of dual use of cigarettes and smokeless tobacco has been neglected. The current study examines tobacco use among a sample of Native American adolescents. Also, it considers how the psychological factor of anger may relate to tobacco use. METHODS The participants were 513 Native American students from a national sample in grades 6, 8, and 10 in the United States. Cluster analysis was used to identify anger types, and these types were compared on their tobacco use. RESULTS Cluster analysis identified four anger types. One type was the Externalizing Type, characterized by the tendency to show externalizing behaviors such as fighting and yelling. This type had an elevated rate of tobacco use. In terms of an odds ratio, the Externalizing Type was about 10 times more likely to smoke, about 6 times more likely to use smokeless tobacco, and about 8 times more likely to show dual use. The majority of dual users were the Externalizing Type. CONCLUSIONS The results suggest that externalizing anger types are more likely to use tobacco, and that smoking cessation programs for teens could be more effective when they address anger issues.

Partnering for Preparedness: The Project Public Health Ready Experience

Effective partnerships between local and state public health agencies and schools of public health have tremendous potential to improve the health of communities nationwide. This article highlights successful collaboration between local public health agencies (LPHA), state health departments, and Academic Centers for Public Health Preparedness (ACPHP) in schools of public health developed through participation in Project Public Health Ready, a program to recognize LPHA emergency preparedness. The projects pilot phase illustrated that LPHAs, state health departments, and ACPHP can effectively work together to improve individual public health worker competency and organizational response capacity in local public health agencies nationwide.

The ADMSEP Milestones Project

ObjectiveCredentialing bodies mandate that a medical school’s curriculum be based upon recognized guidelines. Within the field of psychiatry, the Association of Directors of Medical Student Education in Psychiatry (ADMSEP) has previously published recommended guidelines for the pre-clinical and clerkship curriculum. Ongoing changes within the Liaison Committee on Medical Education’s requirements for medical school curricula, and the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, necessitated review of these guidelines.MethodsADMSEP convened a task force of psychiatric educators to develop a consensus report outlining new guidelines. The ADMSEP membership reviewed and approved this final document.ResultsThe guidelines outline six core learning objectives with corresponding competencies. Each of these competencies specifies accompanying milestones to be achieved through the course of medical school.ConclusionsADMSEP believes these guidelines will aid educators in crafting a school’s psychiatric curriculum. Clearly articulated milestones may foster the further development of validated educational and assessment tools by ADMSEP and other organizations.

Latino/as in Substance Abuse Treatment: Substance Use Patterns, Family History of Addiction, and Depression

This study describes a sample of Latino/as in substance abuse treatment. We were interested in substance use patterns, gender differences, family history of addiction, and depression. Questionnaires completed by Latino/as (N = 209) were identified from 12,000 sets completed by participants in treatment from 1993–2003. Significant gender differences emerged, with Latinas reporting higher rates of stimulant abuse and depression. A family history of substance use disorders in primary or secondary family members was reported by 91% of participants. These data suggest that understanding gender differences related to substance use and depression among Latino/as in treatment warrants attention.

Substance Abuse Patterns and Psychiatric Symptomatology Among Three Healthcare Provider Groups Evaluated in an Out-Patient Program for Impaired Healthcare Professionals

Three impaired health care provider groups (N = 84) (nurses, pharmacists, and providers with prescriptive authority) referred for a substance abuse evaluation at an outpatient-based program were compared on demographic and family factors, substance abuse patterns, and psychiatric symptomology as assessed by the Personality Assessment Inventory. Nurses had the highest rates of family history of addiction, problems with benzodiazepines, and psychiatric comorbidity. Overall, health care professionals endorsed opioids twice as often as alcohol as a preferred substance. Family history of addiction, sex, and psychiatric comorbidity emerged as salient factors among these health care professionals. Clinical implications are examined in light of the current findings.

Residents as Teachers: Psychiatry and Family Medicine Residents’ Self-Assessment of Teaching Knowledge, Skills, and Attitudes

ObjectiveResidents are one of the prime sources of information and education for medical students. As an initial step in supporting residents as teachers, a baseline self-assessment of residents’ knowledge, skills, attitudes, and values related to teaching was conducted among psychiatry and family medicine residents to compare and improve their confidence and skills as teachers.MethodPsychiatry residents (N=12) and family medicine residents (N=23) completed self-assessments of their knowledge, skills, attitudes, and values related to teaching. Residents also were asked to list steps used in the One-Minute Preceptor process and estimate the time each spent in teaching. Descriptive summary statistics were used for four main areas related to teaching; t -test and chi-square analyses were conducted to ascertain whether there was a significant difference in resident groups.ResultsIn the current study, the perceived amount of time spent for teaching patients was significantly higher among family practice residents, whereas no group differences were found for time teaching medical students, peers, community members, non-physicians, or others. However, family medicine residents rated themselves higher than psychiatry residents in their understanding of their roles in teaching medical students and teaching patients. Also, family medicine residents’ self-reported teaching skills were more advanced (82.4%) than psychiatry residents’ (54.2%). They most likely applied at least two different teaching methods in inpatient and outpatient settings, as compared with psychiatry residents. No significant group differences were found in the other 15 items assessing teaching knowledge, skills, attitudes, and values.ConclusionsResults indicate that residents’ knowledge, skills, attitudes, and values regarding teaching varies across institutions and training programs. The psychiatry residents in this study do not clearly understand their role as educators with patients and medical students; they have a less clear understanding of teaching techniques, and report spending less time educating patients than do family medicine residents. The differences might be due to different patient populations and treatment settings. The study suggests that psychiatry residents may have difficulty adapting the One-Minute Preceptor technique in psychiatric settings. Results serve as a benchmarking study in a performance-improvement program to enhance psychiatry residents’ teaching skills.

A Model for Assessing Public Health Emergency Preparedness Competencies and Evaluating Training Based on the Local Preparedness Plan

This paper describes a six-step model to improve the capacity of public health agencies responding to any hazardous event. Developed through a partnership with an academic center and a local public health agency, the model incorporates lessons learned in the National Association of City and County Health Officials (NACCHO) Public Health Ready (PHR) pilot study conducted in 2003. The proposed model integrates aspects of two existing approaches with concepts from the field of emergency management, and emphasizes the importance of timely evaluation. The evaluation of the model includes both individuals workers and larger work groups. It addresses both general goals and the agencys local plan. The model also stresses the need to work with all levels of the agency to develop the local plan. In the model, evaluation is accomplished using self-assessment, measures of objective knowledge, ratings of individual performance, and ratings of team performance. Though based on a pilot study, the model may have application for other agencies working to increase their capacity to respond to hazardous events.