Outpatient clinic structure as a complication to psychoanalytically-oriented treatment

Concepts of “adaptive context” and “holding environment” serve as a foundation from which to address the impact of typical outpatient psychotherapy clinic settings on the process of psychoanalytic therapy. Issues of transference and resistance, treatment boundaries, professional investment, and the patients' and therapists' perceptions of the therapy process are primary areas of consideration. The depth, intensity, and power of psychoanalytically-oriented psychotherapy is seen as potentially limited by the structure and policies to which clinic settings tend to adhere. Circumstances in private practice are used as a point of comparison and suggestions are made to minimize treatment complications.     

The Relationship Between Urinary Tract Infections and the Collegiate Academic Calendar

Abstract

College students believe that they are more likely to be ill during examination periods than at other times in the academic year. We in the health service hypothesized that urinary tract infections are not affected by the demands of the academic calendar.

During a 4-year study, the university health service obtained urine culture data prospectively from 456 patients who had a total of 508 episodes of urinary tract infections. Each year, the number of urinary tract infections decreased during both midterm and final examination periods, but rebounded to higher-than-average levels in the second week following the midterm examination period, as well as during the second week of the second (spring) semester, immediately after the mid-winter recess. Mean duration of symptoms was 34 hours (range, from 12 to 60).

Urinary tract infections were less common during examination periods, when students were preoccupied with academic responsibilities, but such infections increased in frequency in the period immediately after examinations, when sexual intimacy was resumed or when sexual intercourse with a new partner began. Urinary tract infections in college women, the study indicated, are primarily related to sexual intercourse, and susceptibility is only indirectly affected by the demands of the academic calendar.     

Rapid Ethnographic Assessment of HIV/AIDS among Garífuna Communities in Honduras: Informing HIV Surveillance among Garífuna Women

ABSTRACT

Garífuna, an Afro-Caribbean ethnic group in Honduras, have among the highest HIV prevalence rates in Central America; 15- to 49-year-old Garífuna have HIV rates comparable to heterosexual transmission rates in regions of sub-Saharan Africa. The heightened rates in this age range pose a significant risk of vertical transmission from woman to child at birth. In 2006, a Behavioral Surveillance Survey plus Biomarkers (BSS+) reexamined seroprevalence of HIV, sexually transmitted infections, and HIV-related risk behaviors among Garífuna to inform HIV prevention activities and monitor trends in HIV transmission over time. To inform the BSS+ survey protocol, we conducted a rapid ethnographic assessment (REA) in Garífuna communities to specifically examine acceptability among Garífuna to be surveyed, suggest ways to minimize HIV-testing related stigma, and determine female gender-specific concerns among BSS+ respondents. Data were collected in 2 weeks in November, 2004, using a semi-structured interview guide for key informant interviews and focus groups. Seventeen key informant interviews and three focus groups were conducted; participant observation and 11 site visits were also conducted. Major findings included high Garífuna acceptability to participate in the BSS+ with key member involvement and incentives. Maintaining confidentiality at HIV testing sites is required to minimize Garífuna women's risk of intimate partner violence. Recommendations to BSS+ partners from this REA informed the BSS+ study protocol and was expected to increase participation and validity and decrease potential risks associated with women's survey participation.     

The changing pattern of distribution

Over the last decade the domestic distribution function has changed its internal and external appearance in order to meet the needs of the market, and enable companies to remain competitive in the market place.The object of this paper is threefold: firstly, to define what changes have occurred within the domestic distribution system; secondly, to identify the reasons for these changes; and thirdly, to forecast future developments within the marketing channel structure.Recently there have been considerable improvements in productivity within the distribution function leading to both absolute cost reductions and increases in customer service levels. Four main factors are considered to have influenced these changes. Firstly, improved management awareness in the role of the distribution functions. Secondly, a significant number of technical developments affecting the operating activities within the distribution function. Thirdly, structural change within the channel and co-operation between the independent channel memebers. Finally, the external channel environment has changed considerably as a result of urban renewal programmes and increasing Government constraints.The methods by which management could achieve change with the distribution function are identified and an outline is given of the problems which may be encountered in the process.It is forecast that planning activities will play an important role in developing the distribution system to meet the market needs of the future.     

The Uses and Abuses of Co-Therapy

The literature on co-therapy suggests increased interest in this treatment procedure. There is some agreement over advantages and disadvantages, but there is also confusion on indications and counter-indications. This paper summarizes the current use and abuse of co-therapy. The reported clinical experiences of several co-therapist teams, including spouse co-therapists, are also discussed. It appears that co-therapy will remain controversial until outcomes are rigorously measured and compared with the results of other therapeutic modalities in a standardized, acceptable way.     

Abstracts of the Scientific Programs of the American College Health Association Fifty-Seventh Annual Meeting May 22-25, 1979, Washington,D.C.

Abstract

This article focuses on a therapeutic approach to help women deal with the feelings of grief and guilt they may feel as a result of a voluntary termination of a pregnancy. Available medical and psychological literature indicates that, from a public health perspective, significant psychological problems related to an abortion are “minuscule.” Several women the author saw during the 1992/93 academic year who considered themselves to be extremely religious and prolife had undergone elective abortion. They experienced tremendous guilt and grief 4 to 6 months after the procedure. The author recommends that college health center medical and counseling providers who must deal with this issue help the woman validate her loss by revisiting the site of her abortion to reflect upon the experience and to hold a Gestalt dialogue with the fetus to end the relationship. The provider or someone else should accompany the woman to the site because of the increasing potentiality for violence on the part of prolife protesters.     

Financing Rural New England University Health Services: A Pilot Study

Abstract

Patient satisfaction in university health settings has received little research attention, and it is unclear whether the issue is being addressed in college health clinics. Because providers may make their own evaluations of patient satisfaction in the absence of other information, the authors conducted a study to determine whether healthcare providers at a university health clinic could accurately assess patient satisfaction. Ten providers completed a 10-item questionnaire immediately following the medical encounter to rate their perceptions of selected patients' levels of satisfaction. After seeing a healthcare provider, 201 patients completed a comparable questionnaire indicating how satisfied they were with the experience. Responses of providers and patients were compared, using a paired-sample t test. The results showed that providers' ratings were significantly lower than patients' ratings, indicating that providers were unable to judge patient satisfaction accurately. The results suggest that formal evaluations of patient satisfaction should be included in college health services.     

The Political,Social, and Public Health Problems of Binge Drinking in College

Abstract

Despite extensive efforts to decrease alcohol abuse among college students, prevention approaches have had limited success. This study attempted to clarify reasons for this limited success and to identify directions for future interventions by directly interviewing college students on this topic. Five issues were discussed in the focus group interviews: (1) reasons for drinking alcohol, (2) reasons for not drinking alcohol, (3) circumstances surrounding overconsumption of alcohol, (4) topics and methods for prevention, and (5) gender differences in drinking patterns.

The focus group interviews were found to be a valid tool for elucidating sensitive aspects of these issues and the relative importance of these issues to each other. The students revealed how susceptible they are to societal pressures to drink alcohol and how the limitations of their intrapersonal skills affect their alcohol consumption, most notably regarding sexuality issues. The authors contend that improving intrapersonal skills should be a major focus of programs to prevent alcohol abuse.     

Condom Use in Heavy Drinking College Students: The Importance of Always Using Condoms

Abstract

Objective: The authors examined whether alcohol use decreased condom use. Participants: The subjects were heavy-drinking students on 5 different college campuses. Methods: A face-to-face interview, administered between November of 2004 and February of 2007, gathered information about condom use, alcohol use, and other behaviors. Multivariate logistic regression was used to assess predictors of condom use. Results: Of the 1715 participants, 64% reported that they did not always use condoms. Male students who drank heavily were less likely to always use condoms (adjusted odds ratio [AOR] 0.61). Participants with more sexual partners used condoms less when drinking (AOR 1.93 for men, 1.45 for women). Conclusions: Many students do not use condoms consistently, especially those who drink heavily or have multiple sexual partners. Clinicians at student health need to encourage all students to use condoms every time they have intercourse.