[Experience with biofragmentable anastomotic rings].

During 1991-92 we performed 50 bowel anastomoses using the biofragmentable anastomotic ring (BAR). The indications were malignancy (35 cases), Crohn's disease (3), dolichosigma (4), diverticulitis (2), gastric outlet obstruction (2), and 1 each for abdominal trauma, postoperative stricture, and stricture caused by ischemic colitis. The average age was 61; 28 were women and 22 men. The anastomoses were between colon and rectum (21 cases), ileum and colon (18), colon and colon (8), stomach and jejunum (2) and ileum and ileum (1). First stools were passed after an average of 4.7 +/- 2.5 (SD) days and a low-residue diet was well-tolerated after an average of 7 +/- 3.9 days. There were complications in 12 (24%). In 3 others leaks necessitated reoperation. Incomplete small bowel obstruction developed in 6, 4-18 days after operation and lasted 3-11 days. In 2 a perianastomotic inflammation appeared 1-3 weeks after operation and was treated successfully with IV antibiotics and bowel rest. In 1 case a stricture appeared 3 months after surgery and was treated successfully with balloon dilatation. No complications were seen after anastomosing bowel segments proximal to the ileocecal valve. The average time for expelling the BAR in 19 of the 45 patients was 2.5 +/- 0.6 weeks, assessed by weekly X-raying of the abdomen. Although the group of patients was small, our impression is that the method of anastomosis is easy to learn, easy to perform and relatively safe.

Incidence of bulimia in substance misusing women in residential treatment.

The incidence of bulimia in 100 consecutive adult women entering a residential substance misuse treatment program was examined utilizing DSM-III-R self-report data. Fourteen percent of the clients were diagnosed as having a concurrent eating disorder, seven times the community prevalence rate. The demographic variable of race was an important distinguishing characteristic, while age was not. Cocaine addicts had the highest rate of bulimia, while opioid addicts had the lowest. The clinical significance of these data for treatment and future research is discussed.

MMPI profiles of women in codependency treatment.

The Minnesota Multiphasic Personality Inventory (MMPI) profiles of 73 women presenting themselves for treatment of codependency in a 10-day residential setting were examined. Results suggest a significant amount of psychopathology to be present in this population. More than 50% of these individuals produced clinically significant elevations of five or more scales, and 38% produced elevations on six or more scales.

MMPI profiles of impaired nurses.

The MMPI profiles of 42 nurses presenting themselves for treatment of alcoholism or opiate addiction in a residential setting were examined. When comparisons were made, no significant differences in this sample emerged based on sex, level of professional training, or drug of choice. Results suggested that a significant elevation emerged on the Pd scale, and the D scale approached clinical significance. The clinical implications of these data as they impact the treatment of impaired nurses are discussed.

Anxiety and anger among abusers of different substances.

The levels of trait anxiety and trait anger were compared for adult clients in residential treatment with primary diagnoses of alcoholism, cannabis dependence, cocaine abuse and opioid dependence. With a sample of 809 clients results suggested each of these groups to have significantly elevated anxiety and anger scores, compared to non-client samples. However, there were no significant differences on either anxiety or anger scores based on drug of choice.

MMPI profiles of adolescent substance abusers in treatment.

The non-K-corrected MMPI profiles of 243 adolescents presenting themselves for chemical dependency treatment in a residential setting were examined. Results suggested a general lack of psychopathology in this population, although a significant elevation on the Pd scale did emerge. These data are compared to the findings of previous studies with both adolescent and adult populations.

MMPI profiles of cocaine-addicted individuals in residential treatment: implications for practical treatment planning.

The MMPI profiles of 268 clients presenting for residential treatment of cocaine addiction were examined. The results revealed clinically significant elevations on the Pd and Ma scales of this instrument. In addition, elevations approaching clinical significance were found on the D, Pa, and Pt scales. These results are discussed in terms of conducting treatment within the context of an Alcoholics Anonymous/Narcotics Anonymous framework, as well as the implications for relapse prevention planning.

Financing outpatient mental health care: how much does insurance actually help?

Providers of mental health services in both public and private sectors are becoming increasingly dependent on third-party health insurance to cover the costs of outpatient psychotherapy. The present investigation examines reimbursement rates for the cost of the average course of psychotherapy for a sample of industries in one city. Results suggest that insurance coverage should not be viewed as a panacea by mental health providers.

Alcohol use and abuse in college students. II. Social/environmental correlates, methodological issues, and implications for intervention.

This review of alcohol use and abuse in college students presents a summary of the relationships between college student alcohol use and social/environment characteristics. A theoretical integration of the findings of this review with those of Part I of this series supports the prior paper's finding of two patterns of college drinking. This review further suggests that the two types may have differential predictive ability with regard to future problem drinking. Methodological issues in this type of research are reviewed and implications for intervention are considered.

Alcohol use and abuse in college students. I. A review of individual and personality correlates.

This review of alcohol use and abuse in college students presents a summary of the relationships between college student alcohol use and demographic and individual characteristics. A summary of the findings suggests two distinct patterns of alcohol use. For some demographic groups, heavy drinking may be most associated with personal problems, while for others it may be more associated with social and environmental factors. Suggestions for future research of this important issue are presented.

Improving the cost efficiency of services to the chronic inebriate: an unexpected paradox.

An important component of evaluating any mental health or alcoholism treatment service is to examine the accessibility of the facility to individuals in need of such services. The present study examined the question of accessibility of treatment services to the chronic inebriate in terms of program location. Utilization data were compared for periods of time when a "sobering-up" facility was located in the skid row area of downtown Tampa, Florida, and when it subsequently moved to a working-class residential neighborhood 4 miles away. Results suggest that the move resulted in a decrease in inappropriate use of the facility. The potentials for services to the chronic inebriate are discussed.

Weathering the cuts: a Delphi survey on surviving cutbacks in community mental health.

Funding reductions and changes in the priorities of funding agencies have deeply affected community mental health programs. The burden of handling resource scarcity and shifting service priorities falls primarily on the community boards and staff of local agencies. We report a Delphi study in which an expert panel of 106 community mental health center executive directors and government officials generated a list of key strategies that local agencies could take to survive cutbacks. From an initial list suggested by the panel, a consensus was developed on the 15 most important and most feasible strategies. Discussion focuses on the implications and use of these strategies to promote the survival, even growth, of community-based mental health services during times of scarcity.

Pitfalls in planning: contrasting perspectives on mental health and corporate planning.

Planning is a management activity that has been linked to high quality services, organizational growth, and in austere times, to organizational survival. The present study was undertaken to identify the critical barriers that inhibit or derail effective planning. It was predicted that human service and corporate managers would generally agree about the most and least important planning pitfalls in their systems. Discrepancies would be related to differences in the structural characteristics of organizations in the two sectors. Rankings made by 57 senior mental health administrators of the most and least important pitfalls in planning were contrasted with those of 159 corporate executives. Substantial agreement between the two groups of executives was found.

Surviving cutbacks in community mental health: seventy-seven action strategies.

The question of how community mental health centers could best weather cutbacks in funding was addressed in this study. A survey was conducted with a panel of experts in this area yielding a total of 77 action strategies that agencies could utilize in these difficult financial times. These strategies are reported in terms of services, treatment modalities, consultation, education and training, staffing, personnel policies, location of services, finance and business practices, third party reimbursement, overhead and administrative costs, role of the Board, monitoring the external environment and linkages and contacts. It was recommended that these strategies not be utilized as a recipe for survival but rather as a self-study guide by individual agencies.

Crisis telephone counselors' views of clinical interaction situations.

A survey was conducted to determine the degree of frequency and degree of comfort that paraprofessional telephone crisis counselors experience in a variety of clinical interaction situations. An inventory of 100 separate clinical interactions was completed by a sample of crisis counselors. Results indicate that 32 of the 100 situations received ratings suggestive of high levels scene calls, client anger towards the counselor, client expression of positive affect towards the counselor, client resistance, physical and sexual abuse, and anger towards others. Implications of these data for planning future training, supervision and in-service training activities are discussed.

Cooking-smoke as a factor affecting thyroid metabolism and oxygen transport capability.

1. Young Bedouin women found to be prone to illnesses of the thyroid gland and lungs. It was surmised that the cause of both complaints had the same origin: the smoke from cooking over a fire. 2. Laboratory rats were placed in the cooking space in a Bedouin encampment for 2 months. These rats (termed "smoke" animals) were smaller and less active than normal siblings. 3. The smoke animals had increased secretion of thyroid hormones and TSH and the thyroid glands were enlarged, when compared to body weight. 4. Histology of the thyroid showed areas of atrophy, areas of hypertrophy and cysts. There was increased erythropoiesis, allowing for enhanced oxygen transport capability. 5. It is concluded that the smoke, directly, or indirectly by hampering normal lung function, caused a reaction in the thyroid gland, which in turn led to increased production of hemoglobin, probably to guarantee sufficient oxygen for basic cell metabolism.

Alcohol-related advertisements in a college newspaper.

The college newspaper is a powerful socializing force on the university campus. Within the general context of a university-based Alcohol Abuse Prevention Project, the present investigation examined alcohol related advertising in a college newspaper at one southern university. Ads were categorized into those: (1) promoting the responsible use of alcohol, (2) promoting the irresponsible use of alcohol, and (3) having a neutral content. Results indicated that a great deal of alcohol-related advertising was presented in this publication, and the majority of advertising did not promote responsible use of the beverage. The potential role of the community-oriented professional as an intervention strategist is discussed.

Graduate training in clinical psychology: a view from the consumer.

Recent graduates from APA-approved doctoral programs in clinical psychology were asked to rate the adequacy of their training in a variety of skill areas (N = 316). For the most part, respondents were relatively satisfied with their training and were most satisfied with traditional skills in therapy and assessment. Comparisons of males and females, practitioners and academicians, and traditional clinical vs. community-oriented programs resulted in few significant differences. In light of other recent findings, the present results suggest that satisfaction with training and satisfaction with professional work role are not the same. Implications of these results and suggestions for future research are discussed.