Gambling as an addictive disorder among athletes: clinical issues in sports medicine.

This article examines the role of gambling as an addictive disorder experienced by athletes, both college and professional. Gambling may often be seen as a comorbid factor with other addictions and with depression among athletes. The focus on addictions among athletes has gained considerable attention among sports medicine clinicians. Diagnostic indicators, risk and protective factors, and a stage model of addiction among athletes are addressed. An algorithm and pathway of care for athletes with an addictive disorder is offered as are recommendations that sports physicians, sports medicine specialists, coaches and counsellors need to address athletes who have an addictive disorder.

Violence in the schools: clinical issues and case analysis for high-risk children.

School violence in rural communities has gained considerable attention nationally. Examined are theoretical considerations involving escape theory, the risk and protective factors for school violence, case analyses of recent case studies, and discussion of recent school violence involving fatal injuries to others. Also discussed are diagnostic issues in understanding children who are at-risk for school violence and ways school violence maybe managed in the schools. Suggestions and recommendations including recommendations provided by the National School Safety Center for school personnel are offered, as are steps to be taken in creating a safe school environment. This information may be helpful to child psychiatry and clinical personnel who provide services to school aged children.

Sports medicine in the new millennium: a vision for 2020.

Globalisation, empowerment and technological change will determine the emerging directions in sports medicine in the new millennium. Networks and alliances of scientist and clinician services, as well as electronic profiling of athletes' learning styles, genetic predisposition and other variables, will enhance the spectrum of sports medicine services. Visionary direction will require changes in the organisational paradigms employed, the communication of information to athletes and coaches and the methodologies of assessment. An emphasis on prevention science and clinical and educational interventions will require a clearer focus. The sports medicine scientist and clinician of today must utilise the endowments suggested by Covey and the multiple intelligence models advanced by Gardner in capturing the clarity of focus for sports medicine in the new millennium.

Drug use in very rural Alaska villages.

The Alaska Native Preschool Project was centered in the Head Start Programs of two typical Alaska native villages near the Bering Sea. Data were collected over 5 years, 1990 to 1995, from preschool parents (N = 342) with surveys, a panel of villagers (N = 25 to 30) using qualitative interviews; villagers using participant observation; and a limited review of public records. The villages typify the changing life of Alaskan villagers who live in the Bering Straits area. Qualitative data indicated that a number of problems were associated with drug and alcohol use in the villages. The level of smokeless tobacco use from surveys in the previous month among preschool parents (41%) was self-reported to be almost 10 times greater than the national level reported in the 1995 National Household Survey. The use of marijuana reported by preschool parents in the previous month was almost 3 times higher than the 1995 National Household Survey estimates (19 vs 6.7%). Tobacco use in the previous month was reported at over 56%, a level that was over 1 1/2 times the level of use at 34.7% estimated from the 1995 National Household Survey. For 26-34 year olds, previous month alcohol use was lower for the village parents than estimated from the 1995 National Household Survey (38 vs 63%). The self-reported levels of other drug use among preschool parents were very low compared with overall United States rates.

An adolescent vampire cult in rural America: clinical issues and case study.

The emergence of cult related activities in rural America are examined. Cults and their attraction to adolescents are addressed as are methods of cult indoctrination and a profile of cult members and their leader. Clinical management along with a rationale for the attraction of some adolescents to cults are discussed. A case study of a vampire cult and the psychopathology identified in the leader of the cult are provided. Import for clinicians is offered.

Clinical and cultural issues in diagnosing and treating child victims of peer abuse.

Examined are clinical and cultural issues in assessing and treating child victims of peer abuse. Profiles for both victims and perpetrators are discussed as are clinical patterns that may emerge in adulthood. Clinical trauma accommodation is discussed to offer the processing and adaptation to peer victimization. A clinical algorithm is discussed to provide the clinician with a pathway for assessment, treatment and follow-up for children who experience peer victimization.

Post-traumatic stress disorder in children and adolescents of the Armenian earthquake.

The impact of the Armenian earthquake of 1988 on children and adolescents screened through the National Mental Health Research Center in Spitak, Armenia, is discussed. The earthquake caused close to 20,000 deaths, almost two-thirds of which were children and adolescents. Clinical data which address advances in understanding the diagnostic indicators and resulting psychopathology in victims of the Armenian earthquake are presented. Current theory about the processing of trauma in children and adolescents is reviewed, with recommendations for future research in this area.

A state-university collaboration program: residents' perspectives.

Little information is currently available about how residents perceive the recently developed state-university collaboration programs in psychiatry. To determine the opinions of residents participating in the collaboration program in Kentucky, the authors administered a questionnaire to 18 residents who had completed at least one rotation at Eastern State Hospital in Lexington. The questionnaire asked the residents to respond to statements about the clinical, organizational, and educational aspects of the experience. Most respondents rated the experience as favorable, and 78 percent indicated interest in state employment. In addition, the state hospital was noted as one of residents' three future career choices.

An overview of chronic pain.

Pain is the most common symptom for which patients seek medical advice and treatment, and chronic pain takes a heavy toll in patient suffering and disability, reduced quality of life, and economic costs. Despite the interest in pain management in the last half century, the pathways of pain transmission and the optimal methods of pain management are not fully understood. The authors review selected areas of knowledge about chronic pain and its management, including historical views, the assessment of pain, economic factors and costs, and treatment approaches.

Sociocultural stress and the American native in Alaska: an analysis of changing patterns of psychiatric illness and alcohol abuse among Alaska natives.

This paper presents selected morbidity and mortality statistics to outline developing trends and the current status of psychiatric illness and alcohol abuse among the Aleut, Athabascan, Yupik, Inupiat, Tlingit, Haida and Tsimpshian people of Alaska. Analysis of the records of the Indian Health Service, the Community Mental Health Centers and the Alaska Psychiatric Institute, the providers of care for Alaska Natives, shows that the number of individuals treated as inpatients and outpatients for psychiatric illness and alcohol abuse has been rising steadily. Accidental injury and suicidal behavior are common. The treated prevalence rates for these diagnoses exceed recorded rates for other American Native and non-Native groups. For each category of violent death, suicide, homicide, accidents and alcohol, rates for Alaska Natives are higher than rates for Alaska non-Natives, American Indians and the U.S. (all races) and are rising. The data suggest a public health problem in which the primary elements are behavioral disturbance and violent death.