The Role of Community Health Centers in Providing Behavioral Health Care

The prevalence of behavioral health problems is higher for low-income individuals, yet this population is less likely to receive behavioral health treatment. Community health centers have their advantages as behavioral health-care providers because they serve a majority low-income population and are located in medically underserved areas. Their role in providing behavioral health care is expected to expand under health reform as they are expected to double their patient capacity, and due to increased insurance coverage for individuals with behavioral health problems. However, the ability of community health centers to provide behavioral health care is compromised by provider shortages and funding shortfalls.     

A test of concordance between patient and psychiatrist valuations of multiple treatment goals for schizophrenia

Background While much discussion has been placed on the problem of poor compliance in the treatment of schizophrenia, there has been little discussion on the concordance between patients and psychiatrists, an important contributing factor to patient‐centred care. Objective To estimate the concordance between patients’ and psychiatrists’ (ordinal and cardinal) valuations of multiple goals for schizophrenia treatment and to illustrate the utility of the self‐explicated method in valuing a large number of treatment goals. Design Twenty treatment goals were identified during focus groups and literature review and were presented to patients and psychiatrists during structured interviews. Respondents were asked to rank the multiple treatment goals and rate them on a 5‐point Likert scale. Three scores were calculated based on the ranking (1–20), rating (Likert scale) (1–5) and a self‐explicated method estimated as the product of rating and ranking score (1–100). Concordance was tested using Spearman’s rho for overall ordinal rankings and via anova and F‐test for the cardinal values assigned to a specific treatment goal. Participants A total of 105 outpatients diagnosed with schizophrenia and 160 psychiatrists in Germany. Results Patient and psychiatrist values were concordant when the ordinal properties of their valuations were assessed by rating (ρ = 0.63; P = 0.002), ranking (ρ = 0.51; P = 0.02) and self‐explicated methods (ρ = 0.54; P = 0.01). Significant discordances were found when comparing the cardinal value placed on any given treatment goal using all three approaches, but the self‐explicated method produced a more discerning statistic. Relative to patients, psychiatrists significantly (P < 0.05) overvalued reduced lack of emotion, improved sexual pleasure and improved communication while undervaluing reuptake of activities of daily living, improved satisfaction and recovered capacity for work. Conclusions While there is an overall concordance between patients’ and psychiatrists’ valuation, significantly different valuations on specific goals can be identified. Here, psychiatrists tend to focus on ‘textbook’ outcomes, while patients are more concerned with functioning and living a normal life. This study also demonstrates the importance of comparing the concordance in treatment goals and the importance of preference‐based methods, such as the self‐explicated method, in the study of concordance.     

Acute Dieldirin Toxicity: Biochemical Changes in the Blood

The effect of a single sublethal dose of dieldrin on values for plasma corticosterone (free), nonesterified fatty acids, blood glucose, glucose tolerance, blood pyruvic acid, blood lactic acid, and liver lactic acid has been investigated. The blood glucose level is elevated and glucose tolerance is lowered, Indicating an impairment in the utilization of glucose. A significant increase is observed in the levels of other constituents. A correlation of these effects with adrenocortical activity has been attempted.     

δ-Aminolevulinic Acid Dehydratase Test for Lead Exposure

The determination of δ-aminolevulinic acid dehydratase (ALA-D) in erythrocytes is one of the most reliable indicators for evaluating occupational exposure to a low concentration of lead. The ALA-D test is usually performed with incubation at the pH level found in normal blood. However, the optimum pH for determinations of ALA-D in occupational lead exposure is different from, and at a lower pH level compared with, the normal.

Accordingly, I undertook to perform the ALA-D assay by simultaneous incubation at the normal and at a lower pH value, and the results were expressed as the value of an activity ratio in addition to the activity. The activity ratio in the ALA-D test has a close correlation with the level of lead in blood.     

Dietary supplement use among Iranian adults: a study in northern Iran

This study aimed to investigate dietary supplement use among Iranian adults in northern Iran. A cross-sectional study was undertaken on randomly selected men and women in Guilan province, northern Iran. The study population was parents of children and adolescents studying in schools. Totally, 1,425 women and 676 men were studied and data on age, body weight, height, educational level, and supplement use was gathered using a self-administrated questionnaire. These data showed that supplement use was related to sex, body mass index, and educational levels in both sexes. Most common supplements used in this population were Iron, calcium, multivitamin/multiminerals and fish oils. These results showed that 13.3, 3.4, 2.2, and 1.1 % of the study men used iron, calcium, multivitamin/multimineral, and fish oil, respectively. In women, 27.1, 10.7, 5.1, and 5.5 % used Iron, calcium, multivitamin/multimineral, and fish oil, respectively. More educated men and women and those with more healthy weight were more likely to use any dietary supplement than the less educated and overweight/obese men and women. This study showed that iron was the most common dietary supplement in this study middle aged Iranians. Using the other supplements was mostly related to age, educational level, and body weight status in this population. These data indicated that dietary supplement use was inversely related to some health-related behaviors and socioeconomic factors.