Multicultural psychiatric education: using the DSM-IV-TR Outline for Cultural Formulation to improve resident cultural competence.

OBJECTIVE: The authors present a 9-week multicultural competence course organized around the DSM-IV-TR Outline for Cultural Formulation. METHOD: The course alternated large group lectures with experiential small group discussions to acquire knowledge, develop skills, and explore attitudes. The authors evaluated the effectiveness of the course on residents' training and application of multicultural knowledge, skills, and attitudes. Second-, third- and fourth-year residents completed anonymous self-report questionnaires immediately before and after the course and 9 months following the course. RESULTS: Residents' pre- and postcourse scores indicated statistically significant increases in multicultural knowledge, attitudes, and clinical application. Residents did not report additional gains in multicultural knowledge, skills, and attitudes at the 9-month follow-up. CONCLUSION: This multicultural training course resulted in modest gains in resident training in multicultural knowledge, skills, and attitudes. Further study is needed to determine ways to sustain immediate multicultural knowledge and ways to support long-term application of multicultural education.

Pectin does not inhibit intestinal carcinogenesis in APC-deficient Min/+ mice.

APC-germline mutation creates predisposition for intestinal tumorigenesis. APCMin/+ mice, developing tumors preferentially in the small intestine and only minimally in the colon, were fed pectin-enriched diets (10% galacturonan; degree of methoxylation=37.0 and 70.4%) or standard diet. Pectins used in the present study do not inhibit intestinal tumorigenesis and rather accelerate it in APCMin/+ mice. Both pectins exhibited prebiotic effects associated with high fermentative formation of acetate but producing low butyrate. The differences of the short-chain fatty acid concentrations between cecum and colon and those between colon and feces were larger than expected and increased with cancer progression, indicating an inhibition of butyrate absorption. Pectins transported more bile acids toward the colon than the standard diet and caused a higher generation of secondary bile acids despite lower pH values. Overexpression of COX-2 resulted in lower antioxidative capacity, thus promoting cancer. Apoptosis increased in hyperplasia but decreased in late adenomas. When biological modular design principles are taken into consideration, it can be expected that pectin also reinforces colorectal tumorigenesis of patients suffering from APC gene defects.

Effects of job development and job support on competitive employment of persons with severe mental illness.

OBJECTIVES: Few studies have sought to determine which specific supported employment services improve employment outcomes for people with pyschiatric disabilities. This study examined the effects of job development and job support among other services on acquisition and retention of competitive employment. METHODS: Data used in the analysis came from seven sites of the Employment Intervention Demonstration Program. Employment data were collected weekly for a period up to 24 months for 1,340 participants. A random-effects meta-analysis was conducted. RESULTS: Job development increased the probability of obtaining competitive employment. The effects of job development on job acquisition remained after the effects of other factors were controlled for. Job support was associated with more months in the first competitive job but not total hours worked. However, no evidence for the causal role of job support was found in analyses that tested the effects of job support after the job support was provided. The causal role of job support alone was also cast in doubt by the fact that a substantial overlap existed between individuals who received job support and vocational counseling. CONCLUSIONS: Job development is a very effective service when the goal is job acquisition. Job support is associated with retention of a first competitive job, but its causal role is questionable.