Teaching clinic lowers radiology utilization. A look at how to achieve more cost-effective imaging

Discover how an Oregon medical clinic made great strides decreasing radiology utilization after implementing a continuous quality improvement project that was embraced by physicians.     

The relationship between lead and crime

This study investigates the association between air-lead levels and crime rates across 2,772 U.S. counties. Data for the analysis come from the Environmental Protection Agency, the Bureau of Census, and the Federal Bureau of Investigation. Results suggest that air-lead levels have a direct effect on property and violent crime rates even after adjusting for general levels of air pollution and several structural covariates of crime. We also find that resource deprivation interacts with air-lead levels. The association between air-lead levels and crime rates-property and violent-is strongest in counties that have high levels of resource deprivation and weakest in counties that have low levels of deprivation. This interaction is consistent with arguments and evidence in the health care literature that populations most at risk of lead poisoning are least likely to get the resources required to prevent, screen, and treat the illness.     

Determinants of sexual arousal and accuracy of its self-estimation in sexually functional males

Men with and without sexual dysfunction present with varying patterns of agreement between subjective estimates of sexual arousal and more objective psychophysiological measures of the same construct. This relative accuracy seems to be associated with sexual function, with men who have sexual dysfunction presenting less accurate estimations (mostly reporting below measured arousal levels). The purpose of this study is to clarify the processes underlying sexual arousal and the accuracy of its self-estimation. We looked at potential predictors of sexual arousal (subjective and physiological) and accuracy in estimating objective sexual arousal in a sample of 60 sexually functional males. Predictors included pre-existing sexual attitudes (erotophobia), both trait and state positive and negative affect, self-focused attention, and interoceptive awareness. Results indicate that this sexually functional sample generally reported below their own erection level. Interestingly, trait negative affect was associated with somewhat lower levels of subjective arousal and higher levels of physiological arousal. On the other hand, state positive affect facilitated both subjective and objective arousal and increased somewhat the accuracy of estimates of erectile responding. Pre-existing sexual attitudes as well as variations in self-focused attention and interoceptive awareness evidenced little effect on sexual arousal or the accuracy of its estimation.     

IS BOWEN THEORY VALID? A REVIEW OF BASIC RESEARCH

In the last 15 years, a substantial number of studies have tested the theoretical validity of Bowen family systems theory. A review of this basic research provided empirical support for the relationship between differentiation and chronic anxiety, marital satisfaction, and psychological distress. Bowen's assumption that couples with the same level of differentiation marry was not supported. His specific theories of sibling position and triangulation also received little empirical support. Research on multigenerational transmission has generally ignored Bowen's theoretical perspective, and more research needs to test Bowen's claim that his theory is universal. In addition, researchers still need to examine the effect of differentiation on child functioning, physical health problems, and adaptability.     

Cognitive-behavioral therapy for obsessive-compulsive disorder: review of treatment techniques

Obsessive-compulsive disorder (OCD) is a chronic, impairing condition with an estimated lifetime prevalence in adults of 2.5%. Controlled treatment trials have demonstrated that cognitive-behavioral therapy (CBT) is an effective intervention for OCD. However, many individuals diagnosed with OCD do not receive appropriate, empirically validated interventions, perhaps due to limited knowledge of CBT among mental health practitioners. This article provides a review of CBT for OCD. Issues related to treatment delivery and assessment are presented and highlighted by an individual example.     

An integrative intervention for promoting recovery from extramarital affairs

The discovery or disclosure of an extramarital affair can have a devastating impact on partners, both individually and on the relationships. Research suggests that affairs occur relatively frequently in relationships and are a common presenting problem in couple therapy. However, despite their prevalence, there is little empirical treatment research in this area, and most therapists describe this problem as one of the more difficult to treat. In this study, we used a replicated case-study design to explore the efficacy of an integrative treatment designed to help couples recover from an affair. Six couples entered and completed treatment. The majority of these couples were less emotionally or maritally distressed at the end of treatment, and the injured partners reported greater forgiveness regarding the affair. Details of the intervention, suggested adaptations of the treatment, and areas for future research are discussed.     

Men's sexual coercion in intimate relationships: development and initial validation of the Sexual Coercion in Intimate Relationships scale

We report the development and initial validation of the Sexual Coercion in Intimate Relationships Scale (SCIRS), a measure designed to assess the prevalence and severity of sexual coercion in committed intimate relationships. We review existing measures of sexual coercion and discuss their limitations, describe the identification of the SCIRS items, perform a principal components analysis and describe the resulting three components, and present evidence for the convergent and discriminative validity of the SCIRS. Because sexual coercion in intimate relationships often takes the form of subtle tactics, the SCIRS items assess communicative tactics such as hinting and subtle manipulations in addition to tactics such as the use of physical force. The SCIRS provides researchers and clinicians with a valid, reliable, and comprehensive measure with which to study the dynamics of sexual coercion in intimate relationships.