The synopsis record card: a stepping stone to the computer

A synopsis record card has been developed for use in general practice to provide ready reference to the important facts of the patient's record. When such a card is available in the record wallet it is used at 50% of all patient consultations and significantly reduces the time needed to retrieve past data essential to the consultation. The card contains clinical details, and data on medication, drug idiosyncrasies, immunizations, screening procedures, social, occupational and family history and practice research. As synopsis records are particularly important in teaching practices and when referral letters to hospital or personal medical attendant insurance reports are written, provision has been made for the inclusion of data relevant to those functions. So that the card may act as an intermediary for record computerization, all elements needed in the construction of a computer record have been taken into account. The prototype card was circulated to 3000 RCGP members for comment and the majority of replies were favourable. Suggested modifications have been incorporated in the final design of the card.     

Health psychology and the arts: a conversation

Critical approaches within health psychology continue to explore new methods of working and new theoretical ideas from other disciplines. One area that remains under-explored is the potential links with the arts. This special issue contains a selection of empirical and theoretical reports on the linkages between health psychology and the arts. It includes arts and health projects in clinical, community and educational contexts; projects with young and old people, projects with people from different social and ethnic background and projects using different forms of art. This article introduces the special issue and uses a dialogic format to consider some of the broader issues.     

Health psychology in African settings: a cultural-psychological analysis

African settings provide an important context in which to examine the relationship between cultural beliefs and health. First, research in African settings helps illuminate the sociocultural grounding of health and illness: the idea that beliefs play a constitutive role in the experience of distress. Second, research in African settings helps to illuminate the cultural grounding of health sciences: the idea that theory and practice reflect particular constructions of reality. We examine these ideas in the context of three research examples: the prominent experience of personal enemies; epidemic outbreaks of genital-shrinking panic; and fears about sabotage of vaccines in immunization campaigns.     

Translational studies in hematopoietic cell transplantation: treatment of hematologic malignancies as a stepping stone to tolerance induction

Allogeneic hematopoietic cell transplantation (HCT) has most commonly been used to treat hematologic malignancies, where it is often the only potentially curative option available. The success of HCT has been limited by transplant-associated toxicities related to the conditioning regimens used and to the common immunologic consequence of donor T cell recognition of recipient alloantigens, graft-vs-host disease (GVHD). The frequency and severity of GVHD observed when extensive HLA barriers are transgressed has essentially precluded the routine use of extensively HLA-mismatched HCT. Allogeneic HCT also has potential as an approach to organ allograft tolerance induction, but this potential has not been previously realized because of the toxicity associated with traditional conditioning. In this paper we review two approaches to HCT involving reduced intensity conditioning regimens that have been associated with improvements in safety in patients with hematologic malignancies, even in the HLA-mismatched transplant setting. These strategies have been applied in the first successful pilot studies for the induction of organ allograft tolerance in humans. Thus, we summarize an example of vertical translational research between animal models and humans and horizontal translation between two separate goals that culminated in the use of HCT to achieve allograft tolerance in humans.     

Adaptive style in children with cancer: implications for a positive psychology approach

OBJECTIVE: To describe the adaptive style paradigm as a heuristic model for understanding the very positive psychosocial adjustment that has been observed in children with cancer, and to integrate findings regarding repressive adaptive style into a broader positive psychology framework. METHOD: A selective review of the literature on adaptive style, and its' relevance to outcomes of depressive symptoms, posttraumatic stress symptoms, somatic distress, and health-related quality of life in children with cancer. RESULTS: Studies have found children with cancer report low levels of psychological distress. Adaptive style is a much stronger predictor of psychosocial outcomes than is health history. CONCLUSION: Children with cancer represent a flourishing population. A repressive adaptive style is one pathway to resilience in this population. Additional constructs from the domain of positive psychology are reviewed, and a positive psychology model is suggested as a framework for guiding future research in this area.     

Health psychology in context

Over 25 years there has been a remarkable growth of theoretical and empirical studies in health psychology. Its theoretical underpinnings have been largely derivative, its focus primarily clinical, and its subject, the individual. Relatively little attention has been paid to the cultural, sociopolitical and economic conditions which set the context for individual health experience and behaviour. Theories which do not reflect the complex interaction of these variables are unlikely to provide a satisfactory account of individual health. Multidisciplinary efforts are needed at a community level to provide effective interventions which are relevant to the exposure groups being targeted. Health psychology needs measures which are valid and relevant to the general population regardless of culture, gender, social class or age. Putting health psychology into its cultural, sociopolitical and community context is a major priority for future development.     

Health psychology and public health: theoretical possibilities

Public health has either implicitly or explicitly drawn upon a range of psychological theories. This paper identifies four areas where the application of such theory could be developed, health communication, environmental initiatives, the negotiation of behaviour and participation and empowerment. Recommendations are made regarding content, sources and recipient characteristics that can be used to develop targeted health communication campaigns. Psychology also has a role to play in informing structural approaches to prevention. To facilitate this, a framework which focuses on cues, reinforcer and barriers and an understanding of how behaviour is achieved through negotiation and interaction is outlined. Finally we highlight a role for psychology in approaches that focus on participation and empowerment in relation to health.     

Health policy perception and health behaviours: a multilevel analysis and implications for public health psychology

Associations of health policy perception with health behaviours are analysed. Policy perception is differentiated in information about programmes and appraisal of health policy's contribution to policy goals, and conceptualized on the level of: (1) individuals; and (2) populations (as a social climate indicator). Survey data from the Biomed2-Project MAREPS gathered in Belgium, Finland, Germany, The Netherlands, Spain and Switzerland (N= 3343) show that at the individual level, only policy information is associated with utilizing mammography, quitting smoking, physical activity and political participation in creating healthy environments. In contrast, multilevel regression analyses show that policy appraisal is related to physical activity and political participation as a social climate factor. Implications for integrating health psychology and public health within public health psychology are discussed.     

Health psychology and social action

This article reviews the main epistemological approaches within health psychology. It considers the approach based on critical realism and various strategies for linking health psychology with social action. It argues that critical health psychology has a distinct contribution to make in promoting public health as part of the broader movement for social justice and health.     

Phase-specific sensory representations in spinocerebellar activity during stepping: evidence for a hybrid kinematic/kinetic framework

The dorsal spinocerebellar tract (DSCT) provides a major mossy fiber input to the spinocerebellum, which plays a significant role in the control of posture and locomotion. Recent work from our laboratory has provided evidence that DSCT neurons encode a global representation of hindlimb mechanics during passive limb movements. The framework that most successfully accounts for passive DSCT behavior is kinematics-based having the coordinates of the limb axis, limb-axis length and orientation. Here we examined the responses of DSCT neurons in decerebrate cats as they walked on a moving treadmill and compared them with the responses passive step-like movements of the hindlimb produced manually. We found that DSCT responses to active locomotion were quantitatively different from the responses to kinematically similar passive limb movements on the treadmill. The differences could not be simply accounted for by the difference in limb-axis kinematics in the two conditions, nor could they be accounted for by new or different response components. Instead, differences could be attributed to an increased relative prominence of specific response components occurring during the stance phase of active stepping, which may reflect a difference in the behavior of the sensory receptors and/or of the DSCT circuitry during active stepping. We propose from these results that DSCT neurons encode two global aspects of limb mechanics that are also important in controlling locomotion at the spinal level, namely the orientation angle of the limb axis and limb loading. Although limb-axis length seemed to be an independent predictor of DSCT activity during passive limb movements, we argue that it is not independent of limb loading, which is likely to be proportional to limb length under passive conditions.     

Optimization of a 90Sr/90Y radiation source train stepping for intravascular brachytherapy

A steepest-descent gradient algorithm is developed to optimize the stepping of a 90Sr/90Y radiation source train (RST) for intravascular brachytherapy (IVB). The objective function is to deliver a uniform dose in a coronary target vessel and minimize the dose in adjacent normal vessel tissue at the proximal and distal edges of the coronary target vessel. Based on the target length and number of dwell points (number of steps), the algorithm modulates the dwell times and corresponding dwell positions that optimize the weighted addition of staggered EGS4 Monte Carlo (MC) calculated dose distribution from a single RST. Stepping treatment plans are generated for target vessel lengths of 3.0, 3.3, and 3.8 cm. For both the unoptimized and optimized plans, the dose heterogeneity in the target vessel wall, and length of nontarget vessel receiving 3 Gy, is assessed to compare plans. Optimization results show a 14% dose uniformity within the target is achievable for all vessel lengths. Further, the dose in the adjacent normal tissue is lower in the optimized plans than the unoptimized plans. The work presented in this paper provides a model to address the finite length of RST in IVB treatments. While the results presented are specific to the 90Sr/90Y RST, the methods should apply to other finite length RSTs.     

Applied cognitive psychology: Implications of cognitive psychology for clinical psychology and psychotherapy

Cognitive psychology has made numerous contributions to clinical psychology, and these contributions are considered especially with reference to the anxiety disorders. It is argued that there are four major contributions that can be identified. First, the cognitive approach has led to the development of complex models showing the main cognitive processes and structures of relevance to an understanding of anxiety disorders. Second, controlled laboratory studies permit a more detailed investigation of cognitive biases in anxious patients than generally is feasible in more naturalistic settings. Third, the cognitive approach provides relevant evidence with respect to the issue of whether cognitive biases play a role in the development and maintenance of anxiety disorders. Fourth, the enhanced understanding of the anxiety disorders that has arisen from the cognitive approach has had beneficial effects on therapeutic practice in a number of significant ways. In sum, it is claimed that clinical psychology has benefited considerably from cognitive theory and research.     

Assessing frontal lobe functioning in children: Views from developmental psychology

This review presents the potential contribution of developmental psychology to a more complete understanding of the nature of frontal lobe functioning in children. The cognitive construct of “executive function” has been adopted as a possible behavioral marker of prefrontal functioning from infancy through childhood. Instead of focusing exclusively on mature, adult‐level functioning of the frontal lobes, our article reviews evidence for the view that frontally mediated executive functions emerge in the first year of life and continue to develop at least until puberty, if not beyond. A key theme in this review is that measures used to detect executive functions must be developmentally appropriate, and suggestions regarding viable executive function measures are offered. The contribution of the animal models tested by Diamond and Goldman‐Rakic to our understanding of rudimentary executive functions in infancy is discussed. Another behavioral domain, self‐control, is proposed as a possible source of frontal assessment tools for very young children. In addition, several cognitive tasks from developmental psychology are highlighted as potential frontal measures for school‐age children. Critical issues and current problems associated with research in developmental neuropsy‐chology are discussed.