Case management with borderline children: Theory and practice

Case management with borderline children requires collaborative work with parents and teachers in which the focus is on the child's needs and relationships with others. Understanding of borderline pathology from the perspectives of developmental psychology and object relations theory can be used implicitly in management planning and explicitly in enabling parents and teachers to comprehend the issues and goals of the child's therapy.     

Preschool children's ability to identify and label emotions

The present study examined preschoolers' and adults' ability to identify and label the emotions of happiness, sadness, and anger when presented through either the face channel alone, the voice channel alone, or the face and voice channels together. Subjects were also asked to rate the intensity of the expression. The results revealed that children aged 3 to 5 years are able to accurately identify and label emotions of happy, sad, and angry regardless of channel presentation. Similar results were obtained for the adult group. While younger children (33 to 53 months of age) were equally accurate in identifying the three emotions, older children (54 to 68 months of age) and adults made more incorrect responses when identifying expressions of sadness. Intensity ratings also differed according to the age of the subject and the emotion being rated.Support for this research was from a grant by the National Science Foundation (#BNS8317229) to Nathan A. Fox. The research was also supported by a grant awarded to Nathan Fox from the National Institutes of Health (#R01MH/HD17899). The authors would like to thank Professor A. Caron for providing the original videotape, Joyce Dinsmoor for help in data collection and the staff of the Center for Young Children for their cooperation.     

DEPRESSION AND THE SOCIAL DIMENSIONS OF THE FULL-TIME HOUSEWIFE ROLE*

This article examines the determinants of depression among a sample of 528 married, white housewives residing in the southeastern U.S. The multiple regression analysis reveals that low total family income, dissatisfaction with family life and the housewife role, and few extra-familial social contacts are significantly associated with depression. A major finding is that the impact of social contacts in reducing depression is conditioned by the housewife's age and by children's residence in the home. Younger women and those with no children living at home benefit more from extra-familial social contacts than do older women and those who have children at home. The article concludes with a discussion of the impact of the social changes of the 1970s and early 1980s on the determinants of housewives' psychological well-being.     

Evaluation of the Uncertainty in an Oral Reference Dose for Methylmercury Due to Interindividual Variability in Pharmacokinetics

An analysis of the uncertainty in guidelines for the ingestion of methylmercury (MeHg) due to human pharmacokinetic variability was conducted using a physiologically based pharmacokinetic (PBPK) model that describes MeHg kinetics in the pregnant human and fetus. Two alternative derivations of an ingestion guideline for MeHg were considered: the U.S. Environmental Protection Agency reference dose (RfD) of 0.1 g/kg/day derived from studies of an Iraqi grain poisoning episode, and the Agency for Toxic Substances and Disease Registry chronic oral minimal risk level (MRL) of 0.5 g/kg/day based on studies of a fish-eating population in the Seychelles Islands. Calculation of an ingestion guideline for MeHg from either of these epidemiological studies requires calculation of a dose conversion factor (DCF) relating a hair mercury concentration to a chronic MeHg ingestion rate. To evaluate the uncertainty in this DCF across the population of U.S. women of child-bearing age, Monte Carlo analyses were performed in which distributions for each of the parameters in the PBPK model were randomly sampled 1000 times. The 1st and 5th percentiles of the resulting distribution of DCFs were a factor of 1.8 and 1.5 below the median, respectively. This estimate of variability is consistent with, but somewhat less than, previous analyses performed with empirical, one-compartment pharmacokinetic models. The use of a consistent factor in both guidelines of 1.5 for pharmacokinetic variability in the DCF, and keeping all other aspects of the derivations unchanged, would result in an RfD of 0.2 g/kg/day and an MRL of 0.3 g/kg/day.     

Evaluating school capacity to implement new programs

An eight-factor survey-based Bayesian model (Bridge-It) for assessing school capacity to implement health and education programs was tested in secondary analyses of data from 47 schools in the Texas Tobacco Prevention Initiative (TTPI). Bridge-It was used during the pre-implementation phase and again at mid-course of the TTPI 2 years later. Achieved implementation status was evaluated in follow-up almost 4 years after the start of the TTPI. The Bridge-It score aggregated across all eight of the capacity factors predicted both quality of adherence to the Guidelines for School Programs to Prevent Tobacco Use and Addiction and quantity of implementing activity. The school-based leadership factor was an independent predictor of quality of adherence whereas the facilitation processes factor predicted quantity of implementing activity. Integration of Bridge-It, or comparable multi-attribute tools, into the planning and evaluation of school-centered programs can increase understanding of factors that influence implementation and provide guidance for capacity building.     

Mental health and behavioral problems of youth in the child welfare system: residential treatment centers compared to therapeutic foster care in the Odyssey Project population

This is the first multisite, prospective study of behavioral and mental health disorders of youth in residential treatment centers (RTC) and therapeutic foster care (TFC), and the first study to compare the two. This study addressed two questions in a sample of 22 agencies in 13 states: (1) how prevalent were emotional and behavioral disorders in the youth admitted to RTCs and TFC?, and (2) were the youth in RTCs significantly more likely to be disturbed than youth served in TFCs? Data were drawn from the Time 1 phase of the longitudinal national "Odyssey Project" developed by the Child Welfare League of America (1995). Measures included an extensive child and family characteristics form (CFC) and the Child Behavior Checklist (CBCL). The results revealed extremely high levels of behavioral and mental health disorders in the sample as a whole, well above the norms for a non-child welfare population. The prevalence of disorder in the RTC population was substantially greater than in the TFC population.     

Actual versus perceived risk of cervical cancer among college women smokers

Cervical cancer is a well-established smoking-related illness, but many at-risk women are unaware of this link. OBJECTIVE: The authors designed this study to (1) investigate the relationship of smoking behavior with the history of abnormal Pap test results, sexual history, and perceived risk of cervical cancer and (2) determine whether self-classified smoking status (and hence perceived risk) corresponds with actual smoking behavior in a college student population. PARTICIPANTS AND METHOD SUMMARY: College women students (N = 135) completed a survey assessing smoking history, health history, sexual risk behavior, and risk awareness. RESULTS: Relative to those who had not smoked in the past month, current smokers (n = 36, or 27% of the total sample) perceived themselves to be at higher risk for developing cervical cancer, but did not demonstrate increased awareness of specific cervical cancer risk factors, including smoking. Twenty-eight percent (10 of 36) of past-month smokers did not define themselves as current smokers. CONCLUSION: The authors conclude that anti-smoking and health-related messages targeting smokers may misfire for individuals who do not define themselves as smokers but are nonetheless at risk for smoking-related consequences and escalating use.     

Exercise behavior in older adults: a test of the transtheoretical model

The transtheoretical model (TTM) was developed as a guide for understanding behavior change. Little attention has been given, however, to the appropriateness of the TTM for explaining the adoption of exercise behavior in older adults. The purposes of this study were to determine the reliability of the TTM instruments and validate TTM predictions in 86 community-dwelling older adults (mean age 75.1 +/- 7.0 years, 87% women) who were participants in a 16-week walking program. TTM construct scales--self-efficacy, decisional balance (pros and cons), and processes of change (behavioral and cognitive)--were generally reliable (all>.78). Behavioral processes of change increased from baseline to follow-up, but pros, cons, and cognitive processes did not change among participants who became regular exercisers. Stage of change did not predict exercise adoption, but baseline self-efficacy predicted walking behavior. These results lend partial support to the TTM in predicting exercise behavior.