Providers' perceptions of how rural consumers access and use mental health services

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.     

The role of natural recovery in alcoholism and pathological gambling

While most pathological gamblers, like most alcohol abusers, recover on their own, it seems likely that they are at greater risk for relapse than those who have been through successful treatment. Accordingly, a substantial increase in treatment resources for pathological gamblers, along with greater efforts to establish the effectiveness of these treatments, ought to receive national priority. If the data on alcohol-abusing self-changers are generalizable to self-changing pathological gamblers, the prognosis for gamblers who stop gambling all together is better than for those who aspire to controlled or nonproblem gambling. While pathological gamblers with comorbid substance abuse are more difficult to treat than those without it, the impact of comorbid substance abuse on the decision by pathological gamblers to change has not yet been explored, although it should be. Similarly, the impact of other Axis I pathology on pathological gambling self-change, especially depression and anxiety, should be thoroughly explored. The most pressing problem in this field appears to be definitional. As a consequence, until consensus is reached on a reliable, valid, and useful classification scheme for pathological gambling, both research and clinical efforts will continue to suffer.     

The role of theory in the assessment of sex offenders

No generally accepted theory of sex offender behavior exists at this point. As clinical experience and research findings interact within an evolving theoretical framework, the picture of what is important, as well as what is possible to know about a sex offender, is rapidly changing. It is vital that mental health professionals, the legal system, social service agencies, and other consumers and providers of sex offender assessments be aware of both what is possible to learn about an offender as well as the limitations on that knowledge and its application. Prominent theories that influence the assessment of offenders in North America and Europe are presented and examined. Uses and limitations of each theory are discussed. Several trends emerge which could influence the future of sex offender assessment, treatment, management, and policy.     

"He is everything": religion's role in the lives of immigrant youth

Using emergent theme analysis of qualitative interview data in combination with quantitative survey data, the role of religion in the lives of immigrant youth was explored. Latino, Haitian, and Chinese teenagers described, in their own rich words, the significance of religion to them; their responses are reflected in themes that point to the potential protective role of religion for some immigrant groups.     

Vitamin B1 blocks damage caused by hyperglycemia

Diabetes accelerates the aging process and leads to complications that include blindness, renal failure, nerve damage, stroke, and cardiovascular disease. It has been hypothesized that high plasma glucose concentrations are responsible for increased mitochondrial free radical production and subsequent inactivation of glyceraldehyde phosphate dehydrogenase (GAPDH) in vascular endothelial cells and other cells implicated in these complications. As a result of the decreased ability of GAPDH to process upstream metabolites, three pathways of metabolic damage are activated, which include the advanced glycation end-product formation pathway, the protein kinase C pathway, and the hexosamine pathway. All three pathways have been implicated in abnormal cell signaling in diabetes. A group of German and U.S. scientists has now found that treating diabetic rats with high doses of benfotiamine, a lipid-soluble form of vitamin B1, can prevent diabetic retinopathy and all three forms of metabolic damage by stimulating transketolase activity and thus diverting excess metabolites toward the pentose pathway. Although vitamin B1 is available over the counter, the researchers at this time do not advocate self-treatment without further clinical data.     

Making quality a fundamental part of strategy

All that is known about strategy and strategic planning indicates that quality is a major factor in gaining competitive advantage. It is cost effective, profitable, promotes corporate longevity and builds an important company value system. The authors argue that is too important a factor to be left solely to quality control personnel or planners and is a fundamental part of the chief executive's responsibility for the development of strategy.     

Mlonte Carlo Techniques for Quantitative Uncertainty Analysis in Public Health Risk Assessments

Most public health risk assessments assume and combine a series of average, conservative, and worst-case values to derive a conservative point estimate of risk. This procedure has major limitations. This paper demonstrates a new methodology for extended uncertainty analyses in public health risk assessments using Monte Carlo techniques. The extended method begins as do some conventional methods--with the preparation of a spreadsheet to estimate exposure and risk. This method, however, continues by modeling key inputs as random variables described by probability density functions (PDFs). Overall, the technique provides a quantitative way to estimate the probability distributions for exposure and health risks within the validity of the model used. As an example, this paper presents a simplified case study for children playing in soils contaminated with benzene and benzo(a)pyrene (BaP).