HMOs and the Future of Student Mental Health Services

Abstract

The health maintenance organization (HMO) is likely to have a prominent position under national health insurance, which will have a strong systematizing effect on the nation's health services. Over the past two years the University of Massachusetts mental health services have provided benefits at both the university and a private medical group practice. Experience has shown that a university which already provides broad services to a large student population can extend itself to the university community including its faculty and staff. Several advantages of this development, as well as some significant problems, are discussed. As the HMO grew and quality services were established, it became feasible for the private medical group to develop its own mental health component. Based on this and other experiences in mental health delivery systems, certain conclusions are drawn about the ways universities can develop HMOs and some recommendations are made for national mental health planning.     

Safety of a meningococcal group B vaccine used in response to two university outbreaks

Objective: To assess the safety of meningococcal group B (MenB)-4C vaccine. Participants: Undergraduates, dormitory residents, and persons with high-risk medical conditions received the MenB-4C vaccine two-dose series during mass vaccination clinics from 12/2013 through 11/2014. Methods: Adverse events (AEs) were identified by 15 minutes of observation postvaccination, spontaneous reports, surveys, and hospital surveillance. Causality was assessed for serious adverse events (SAEs). Results: 16,974 persons received 31,313 MenB-4C doses. The incidence of syncope during the 15-minutes post-dose 1 was 0.88/1000 persons. 2% of participants spontaneously reported an AE (most common were arm pain and fever). 3 SAEs were suspected of being caused by the vaccine, including one case of anaphylaxis. Conclusions: Most AEs reported were nonserious and consistent with previous clinical trial findings. Measures to prevent injury from syncope and to treat anaphylaxis should be available wherever vaccines are administered. Our safety evaluation supports the use of MenB-4C in response to outbreaks.     

Betting the future online

The Internet has brought, among other things, the online betting exchange. From desks in the City or from laptops on sunny beaches, those in the know or out of it can place bets with each other on anything under the sun, whether likely—Australia beating England at cricket—or the reverse. If you have a hunch that a genetically engineered Tyrannosaur will wander down Oxford Street next year, and if you want to put money on it, Internet betting exchanges will find someone to accommodate you. Leighton Vaughan Williams explains how a simple change in tax regime has brought something other than just a more efficient gambling system. It has created a strangely accurate way of foretelling the future.     

Decision-making in betting markets

The placing of a bet is a classic example of decision-making under uncertainty. A betting market is also an example of a simple financial market, but one which possesses the advantage that each bet is characterised by a well-defined end point at which it possesses a definite value, i.e. the amount won or lost. Leighton Vaughan Williams explains the implications for our understanding of economic decision-making of the observed tendency for the expected returns on bets to differ markedly at different odds levels.     

Nocturnal Omissions: Steps Toward a Sociology of Dreams

The examination of dreams should properly be a legitimate topic of sociological investigation. We argue that there are four basic principles of dream-life that suggest that dreams are external to the individual mind and are collective enterprises: 1) dreams are not willed by the individual self; 2) dreams reflect social reality; 3) dreams are public rhetoric; and 4) dreams are collectively interpretable. With the development of sociological approaches that examine topics previously defined as psychological, such as the sociology of emotion and cognition, the seemingly idiosyncratic components of these nocturnal productions should not exclude them from social analysis.     

Some things in life can’t be ‘Googled:’ A narrative synthesis of three key questions in outdoor education.

In countries worldwide, Outdoor Education (OE) offers rich possibilities for learning. OE has been researched for many decades; however the field lacks an integrating framework for its different historical, geographical and disciplinary conceptualisations. The outcomes of OE programmes are well documented and appear diverse, yet also have common attributes suggesting there is scope for unifying approaches. Although substantive barriers to the conduct of OE programmes have been identified, these have seldom been synthesised. This paper offers a narrative review of the literature addressing three key questions designed to look rearward at where OE has come from: (i) how is OE conceptualised, and what theoretical models have been used in OE? (ii) what evidence exists regarding the effectiveness of OE programmes? (iii) what are the barriers to conducting OE programmes? The paper then advances onward with an integrated framework for reconceptualising OE and providing insights into how the field may be strengthened and augmented.20124