Psychotherapy for depression: current and future directions in research, theory, practice and public policy

This article is based on a symposium held at the 1998 Annual Meeting of Society for Psychotherapy Research (Snow Bird, Utah). Recognized experts addressed current and future directions in psychotherapy for depression from the perspectives of process and outcome research, basic research, theoretical models, clinical practice and training, and public policy. The specific issues discussed at the symposium included the strengths and limitations of major forms of psychotherapy; the therapeutic factors common and unique to different approaches; the future viability of current theories of depression; the role of treatment manuals in clinical practice and training; the development of new interventions based on basic research; and the priorities that should guide federal funding.     

Food protein-induced enterocolitis syndrome,from practice to theory

Food protein-induced enterocolitis syndrome (FPIES) is an allergic disease, probably non-IgE-mediated, with expression predominantly in the GI tract. The most characteristic symptom is repeated, debilitating vomiting. It occurs 2?6 h after ingestion of culprit food and is usually accompanied by pallor and lethargy. There may be diarrhea, and in 10?20% of cases, severe hypotension. These symptoms resolve completely within a few hours. The food most frequently involved is cow’s milk, followed by rice, but many other foods may be involved. The prognosis is generally good in a few years. In this review the authors try to cope, with the help of some case histories, with the practical clinical aspects of FPIES. The authors also try to provide a management approach based on current knowledge, and finally, to point out the aspects of FPIES that are still controversial.     

Community health,community involvement,and community empowerment: Too much to expect?

The Primary Prevention of Cancer Program at the British Columbia Cancer Agency Centre for the Southern Interior (BCCA‐CSI), known as the Waddell Project, is now five years old and currently is in partnership with fourteen regional communities. Each of these communities has a range of community‐developed programs currently in place. The driving force behind the Waddell Project comes from the belief that emancipatory change is central to community health. That is, only those communities that are capable of challenging, questioning, and creating change can make the cancer‐prevention decisions that are relevant, useful, and sustainable within the context of the daily lives of their members. The resulting model for the project was influenced by Habermas's Theory of Communicative Action, from which are derived the project's guiding concepts of equality, negotiated content, collaborative process, inclusion of critique, importance of action, and mutual accountability. In this article, these concepts are revisited from the unique contexts and perspectives of the collaborating participants. Implications would suggest that the processes adopted to support empowered community engagement in cancer prevention are, in many ways, more beneficial than the implementation of the resulting initiative itself. Furthermore, it would seem that, rather than funding, it is prolonged and supportive commitment that is the most crucial factor for facilitating emancipatory change in community health. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 217–228, 2004.     

Intrapersonal and interactional empowerment: Implications for theory

This study builds on previous research linking empowerment theory with community participation. Empowerment theory has been criticized as overly individualistic and conflict‐oriented resulting in an emphasis on mastery and control rather than cooperation and community. The purpose was to develop a measure of interactional empowerment (assessing intellectual understandings of power and social change) and compare scores on this measure with scores on a measure of intrapersonal empowerment (assessing one's personal sense of control and efficacy). Results found that persons with greater levels of intrapersonal empowerment reported participating in community activities with greater frequency than persons with lower levels of intrapersonal empowerment. Persons with greater levels of interactional empowerment reported participating in organizational activities and having a stronger sense of community than persons with lower levels of interactional empowerment. © 2000 John Wiley & Sons, Inc.     

Teenage health and the practice nurse: choice and opportunity for both?

Teenage health issues and the means to address them have caused increasing concern over recent years. This study investigated the involvement and training of practice nurses, the topics raised during consultations with teenagers, and the comfort of the practice nurses in dealing with these topics. Data were collected using a postal questionnaire survey (response rate 80.6%). Expansion of the role of the practice nurse in teenage health may be appropriate but needs to be supported by training.     

Preventive care in general practice in Australia: a public health perspective

There is considerable potential in Australia for implementing effective preventive care strategies in the general practice setting, especially in the context of Australia's new health goals and targets towards the year 2000. There is a clear need for the clinical paradigm, which focuses on developing efficacious, intensive, practitioner-delivered lifestyle change interventions, to be integrated within a broader public health approach. However, while there has been considerable growth in the breadth and variety of health promotion research and activity being carried out in general practice in Australia, the evidence supportive of the efficacy and effectiveness of physician-based interventions (except in the case of smoking cessation) has been less than compelling, and a number of problems still remain. These include: health promotion still remains a minor component of the great majority of consultations; there are many potential interventions which are possible, but little evidence that they will be used appropriately; there is little evidence that patients who are most in need are receiving appropriate services; there is generally a poor linkage between research and practice; and there are real doubts about the ability of the system to sustain preventive care in general practice.     

Towards probabilistic decision support in public health practice: Predicting recent transmission of tuberculosis from patient attributes

ObjectiveInvestigating the contacts of a newly diagnosed tuberculosis (TB) case to prevent TB transmission is a core public health activity. In the context of limited resources, it is often necessary to prioritize investigation when multiple cases are reported. Public health personnel currently prioritize contact investigation intuitively based on past experience. Decision-support software using patient attributes to predict the probability of a TB case being involved in recent transmission could aid in this prioritization, but a prediction model is needed to drive such software.MethodsWe developed a logistic regression model using the clinical and demographic information of TB cases reported to Montreal Public Health between 1997 and 2007. The reference standard for transmission was DNA fingerprint analysis. We measured the predictive performance, in terms of sensitivity, specificity, negative predictive value, positive predictive value, the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC (AUC).ResultsAmong 1552 TB cases enrolled in the study, 314 (20.2%) were involved in recent transmission. The AUC of the model was 0.65 (95% confidence interval: 0.61–0.68), which is significantly better than random prediction. The maximized values of sensitivity and specificity on the ROC were 0.53 and 0.67, respectively.ConclusionsThe characteristics of a TB patient reported to public health can be used to predict whether the newly diagnosed case is associated with recent transmission as opposed to reactivation of latent infection.     

From public health genomics to precision public health: a 20-year journey

In this paper, we review the evolution of the field of public health genomics in the United States in the past two decades. Public health genomics focuses on effective and responsible translation of genomic science into population health benefits. We discuss the relationship of the field to the core public health functions and essential services, review its evidentiary foundation, and provide examples of current US public health priorities and applications. We cite examples of publications to illustrate how Genetics in Medicine reflected the evolution of the field. We also reflect on how public-health genomics is contributing to the emergence of “precision public health” with near-term opportunities offered by the US Precision Medicine (AllofUs) Initiative.     

DNA vaccines for poultry: the jump from theory to practice

DNA vaccines could offer a solution to a number of problems faced by the poultry industry; they are relatively easy to manufacture, stable, potentially easy to administer, can overcome neonatal tolerance and the deleterious effects of maternal antibody, and do not cause disease pathology. Combined with this, in ovo vaccination offers the advantage of reduced labor costs, mass administration and the induction of an earlier immune response. Together, this list of advantages is impressive. However, this combined technology is still in its infancy and requires many improvements. The potential of CpG motifs, DNA vaccines and in ovo vaccination, however, can be observed by the increasing number of recent reports investigating their application in challenge experiments. CpG motifs have been demonstrated to be stimulatory both in vitro and in vivo. In addition, DNA vaccines have been successfully delivered via the in ovo route, albeit not yet through the amniotic fluid. Lastly, a recent report has demonstrated that a DNA vaccine against infectious bronchitis virus administered via in ovo vaccination, followed by live virus boost, can slightly improve on the protective effect induced by the live virus alone. Therefore, DNA vaccination via the in ovo route is promising and offers potential as a poultry vaccine, however, efficacy needs to be improved and the costs of production reduced before it is likely to be beneficial to the poultry industry in the long term.     

The utility of the environmental scan for public health practice: lessons from an urban program to increase cancer screening

The environmental scan is a tool that can be utilized to collect data to design health programs uniquely tailored to the needs of communities. However, it remains relatively undefined, unevaluated and underutilized in the field of public health. While individual studies indicate the utility of the environmental scan for public health, it is difficult to find a theoretical framework or guidelines on how to design, implement or evaluate the process within public health practice. The purpose of this study was to elicit lessons learned to maximize the utility of the environmental scan as a tool for public health. This process occurred through the development and implementation of an environmental scan as part of the needs-assessment phase of a project to increase cancer screening among African Americans in Baltimore, MD. Data collection methods for the environmental scan included a review of community stakeholders, cancer incidence and community assets and liabilities in target communities, focus-group sessions and key informant interviews with service providers. The environmental scan was conducted in 2003 and allowed for rapid acquisition and use of information about events, trends and relationships in the neighborhoods targeted for our project and enabled researchers to move forward with implementing the cancer-screening project. The researchers conclude that the environmental scan has considerable potential to be a creative, responsive, cost-effective and mobilizing tool for public health practice. However, further application and critical review are necessary to make it a more effective public health tool and an established research methodology.     

The relevance of attachment theory to the philosophy,organization, and practice of adult mental health care

This review is an inquiry into the relevance of attachment theory to the current philosophy, organization, and practice of adult mental health care, via an examination of the literature relating to attachment theory and, in particular, the literature relating to research into adult attachment. The review does not seek to critique attachment theory itself, but considers carefully the relevance of the theory to adulthood and to the field of adult mental health. In so doing, research into individual difficulties is examined, as is the provision and delivery of therapeutic services. In addition, the literature regarding the importance of mental health staff's own attachments and the influence of attachment theory on mental health service philosophy and organization are evaluated. Finally, potential areas for future research and development in this field are suggested.     

Highlights from the 2016 HIV diagnostics conference: The new landscape of HIV testing in laboratories,public health programs and clinical practice

The 2016 HIV Diagnostics Conference, held in Atlanta, Georgia, was attended by public health officials, laboratorians, HIV testing program managers, surveillance coordinators and industry representatives. The conference addressed test performance data, the implementation of new testing algorithms, quality assurance, and the application of new tests in a variety of settings. With regard to the recommended Centers for Disease Control and Prevention/Association of Public Health Laboratories HIV laboratory testing algorithm, the conference featured performance data, implementation challenges such as a lack of test options for the second and third steps, as well as data needs for new tests that may be used as part of the algorithm. There are delays when nucleic acid testing is needed with the algorithm. Novel tests such as point of care nucleic acid tests are needed on the U.S. market to readily identify acute infection. Multiplex tests are being developed which allow for the simultaneous detection of multiple pathogens. CDC staff highlighted new guidance for testing in non-clinical settings. Innovative approaches to linking testing and care in some settings have led to identification of early infections, improved receipt of test results and expedited initiation of therapy. Work continues to optimize testing so that infections are accurately identified as early as possible and time to treatment is minimized to improve health outcomes and prevent transmission.