Paul F* is a 16-year-old White boy who lives with his mother and spends some weekends with his father who has shared custody. He recently presented to the clinic for treatment due to an arrest for disorderly conduct at school. He and a friend were found drinking liquor outside the school building when they were scheduled to be in class. Paul reported that he and his friends often drink at school and at extracurricular functions. He has been using alcohol for the past 2 years, with escalating consumption (5 or more drinks per episode) in the past year. Paul has been drinking most days of the week and has even driven under the influence at times. He said, "I just feel happier when I am drinking." An accomplished soccer player recruited by colleges, Paul recently was suspended from the team due to his poor grades. His response was, "It's stupid anyway. What's the point of playing?"

A full biopsychosocial interview is key, including use of an efficient tool such as the S2BI questionnaire to quickly stratify risk level and to guide follow-up decisions.

BACKGROUND:The professional advancement of Family Medicine faculty requires contributions in the form of clinical service, teaching, and scholarly activity. While teaching and clinical work are part of the everyday routine of faculty members, a research culture can be challenging to build.METHODS:Our department started a Scholarly Works and Activities Group (SWAG). The group's aim is to promote a collegial, collaborative research culture in the department. Meetings occur monthly, and faculty have the opportunity to discuss scholarly projects with peers, as well as promotion/tenure goals. Minutes from each meeting are sent to all faculty members in the department. The aim of this retrospective study was to determine if SWAG meetings impacted faculty scholarly activity. Data were collected on presentations, publications, and collaborations from Curriculum Vitae (CVs), and were compared between 5 years prior to the intervention and the 5 years since.RESULTS:Results indicated increased scholarly activity in the time period during the SWAG group meetings. Faculty presentations increased by 34% while faculty publications more than doubled (221% increase), with publications constituting a small Cohen's d effect size. Interestingly, faculty collaboration did not increase. Two faculty members were promoted during the 5 years study period, and the total number of faculty who published went from three to eight.CONCLUSIONS:Implementation of a monthly SWAG meeting led to an increase in faculty peer reviewed publications. Furthermore, two faculty members were promoted during the time of the intervention. A monthly faculty meeting, even when brief, can help promote and build a research culture.

The Forum for Behavioral Science in Family Medicine was established in 1980 to create opportunities for behavioral scientists to share their work, collaborate with others, and find support. Over four decades, the Forum grew from a local gathering of colleagues to a meeting with presenters and participants from around the globe. Presentations furthered the scientific basis of what we do while supporting the dissemination of creative and meaningful methods for educating physicians, caring for patients, and maintaining wellbeing. 2019 marked the 40th anniversary of the Forum with the theme The Evidence, the Art, the Outcomes. This special issue of The International Journal of Psychiatry in Medicine presents nine articles drawn from that conference. Strong threads of behavioral science have run through the tapestry of family medicine since its establishment as a specialty in 1969. Like the strong vertical warp threads of a tapestry, scientific evidence creates a necessary framework. Behavioral scientists joined the faculty of residency programs and medical schools. They conducted research in communication skills, educational strategies, behavior change counseling, family systems, disparities, the treatment of psychiatric disorders, and wellbeing. This scholarship contributed to the strong foundational warp in family medicine’s tapestry alongside other medical topics.

Bipolar disorder is a psychiatric illness that is relatively common among patients presenting for treatment in primary care clinics. Physicians in primary care often face difficult decisions about how and when to intervene when a patient is experiencing depressive, manic, or hypomanic episodes consistent with bipolar disorder. This article reviews the literature on how to assess and diagnose bipolar disorder in primary care, and how to choose from the array of treatment options that exist. The psychotherapy and pharmacotherapy evidence base provides guidance on how to help patients effectively manage this ailment. Collaboration among health and mental health practitioners is key in helping manage the “peaks and valleys” of bipolar disorder. Special considerations need to be made to routinely assess for impulsivity, suicidality, and patient progress throughout the course of treatment.

Importance Approximately 24 million US individuals receive care at federally qualified health centers, which historically have low rates of colorectal cancer screening. The US Preventive Services Task Force recommends routine colorectal cancer screening for individuals aged 50 to 75 years. Objective To determine the effectiveness of an electronic health record (EHR)-embedded mailed fecal immunochemical test (FIT) outreach program implemented in health centers as part of standard care. Design, Setting, and Participants This cluster randomized pragmatic clinical trial was conducted in 26 federally qualified health center clinics, representing 8 health centers in Oregon and California, randomized to intervention (n = 13) or usual care (n = 13). All participants were overdue for colorectal cancer screening during the accrual interval (February 4, 2014 to February 3, 2015). Interventions Electronic health record-embedded tools to identify eligible adults and to facilitate implementation of a stepwise mailed intervention involving (1) an introductory letter, (2) a mailed FIT, and (3) a reminder letter; training, collaborative learning, and facilitation through a practice improvement process. Main Outcomes and Measures Effectiveness was measured as clinic-level proportions of adults who completed a FIT, and secondarily, any colorectal cancer screening within 12 months of accrual or by August 3, 2015. Implementation was measured as clinic-level proportions of adults who were mailed an introductory letter and ordered a FIT. Results Twenty-six clinics with 41 193 adults (mean [SD] age, 58.5 [6.3] years; 22 994 women) were randomized to receive the direct mail colorectal screening intervention (13 clinics; 21 134 patients) or usual care (13 clinics; 20 059 patients). Compared with usual care clinics, intervention clinics had significantly higher adjusted clinic-level proportion of participants who completed a FIT (13.9% vs 10.4%; difference, 3.4 percentage points; 95% CI, 0.1%-6.8%) and any colorectal cancer screening (18.3% vs 14.5%; difference, 3.8 percentage points; 95% CI, 0.6%-7.0%). We observed large variation across health centers in effectiveness (FIT completion differences range, −7.4 percentage points to 17.6 percentage points) and implementation (proportion who were mailed a FIT range, 6.5% to 68.2%). The number needed to mail to achieve a completed FIT was 4.8 overall, and 4.0 in clinics that mailed a FIT reminder. Conclusions and Relevance An EHR-embedded mailed FIT outreach intervention significantly improved rates of FIT completion and rates of any colorectal cancer screening. Higher rates of colorectal cancer screening occurred in clinics that successfully implemented the mailed outreach program. Trial Registration ClinicalTrials.gov identifier:NCT01742065

Several DSM-5 criteria lasting 6 months or longer can help identify complicated grief, as can available assessment tools. Treatment has a unique focus.

ADHD diagnostic criteria are different for adults than they are for children. Plus, prescribing psychostimulants for adults raises the risk of misuse and diversion.

Objectives: In Appalachia, tobacco smoking rates are significantly higher than the United States average, and many of the comorbidities that exist with tobacco are prominent. The researchers investigated the impact of tobacco smoking on patients for one year of health outcomes at our resident primary care clinic. Methods: The present study examined outpatient clinic charts and hospital records for a calendar year to determine patient self-reported tobacco rates. Patient medical comorbidities were tracked as well as rates of hospital utilization during the calendar year, and those figures were compared for a group of 90 patients who currently smoke and another group of 90 patients who have never smoked. Results: Tobacco smokers in the present study were more likely to have a history of several medical comorbidities including COPD, musculoskeletal problems, psychiatric treatment, and substance abuse issues. Additionally, tobacco smokers were more likely to have visited the emergency department and to have been admitted to the hospital during the year. Conclusions: The problem of tobacco smoking is complex and primary care clinics provide a wealth of information to investigate numerous comorbid concerns. Consistent with prior research, tobacco users in this study were at greater risk for many medical problems.

Health care delivery systems are increasingly embracing models of integrating behavioral health care with medical care, provided in primary care, settings. Because of the broad range of patient presenting problems, the numbers of patient contacts occurring on a daily basis, and the brevity of encounters, psychologists who accept positions in these settings must acquire distinctive competencies needed to practice effectively. Although these competencies have been articulated clearly, most training programs were not designed to ensure all graduates acquire them. The purpose of this study is to provide examples of how distinctive primary care, competencies can be acquired concurrently with the broad and general competencies associated with becoming a health service psychologist in 3 programs: a doctoral; internship, and postdoctoral program. Through examination of programs that provide this type of training, other programs are urged to review and revise their curricula to ensure that the next generation of health service psychologists possesses the competencies required to practice effectively.

Heart disease claims the lives of 25% of women in the United States. Only about half of women recognize it as the number one cause of adult female mortality, indicating a gap in the public's knowledge base. In West Virginia, women often face barriers such as social isolation, lack of healthy lifestyle options and fewer physician visits.Literature review focused on successful efforts to remedy barriers in Appalachian women with strategies such as community outreach, group, and individual education.Primary care doctors can get involved by providing personalized information on heart health risk and utilizing appointments as opportunities for preventative heart health treatment.Future initiatives should highlight the need for brief, accurate risk assessments and continued encouragement to decrease cardiac risk factors. An ongoing West Virginia Rural Scholars project is aimed at achieving those two aforementioned goals: increasing awareness and reducing risk factors for women's heart health.

Objective: The primary purpose of this article is to review the unique wellness factors that affect physicians practicing in rural communities. Research has indicated that rural communities often struggle to attract and retain primary care physicians and numerous wellness factors impact these attraction/retention rates. Method: Articles selected for inclusion in this review were determined based upon their relevance to rural physicians, overall wellness factors of physicians, and recruitment and retention of physicians in rural communities. Articles were included from peer-reviewed journals focusing upon both medical and psychological perspectives of rural physician wellness factors. Results: Results indicated that rural physicians often have fewer resources, an increased workload, and longer hours when compared to their urban counterparts. These factors contribute to lower job satisfaction, poor retention rates, and decreased physician wellness. Research also demonstrates that physicians who are unwell are more likely to experience substance abuse, depression, relationship difficulties, and general psychological distress. These issues are particularly prominent in rural practice settings and may have significant impact upon rural patients. Conclusion: To date, there are few assessment measures available to assess physician wellness and no evidence-based treatments to address wellness deficits in rural physicians' medical or psychological health. Such resources would have the potential to benefit individual rural physicians and the quality of healthcare they deliver to rural communities. Future research should focus upon the assessment and promotion of rural physician well being, which may improve recruitment and retention of quality physicians to provide optimal care in rural communities.

Physicians often struggle with how to manage the task of breaking bad news with patients. Moreover, the arduous nature of the task can contribute to physician detachment from the patient or an avoidance of breaking the news in a timely manner. A plan of action can only improve physician confidence in breaking bad news, and also make the task more manageable. Over a decade ago, Rabow and McPhee offered a strategy; the ABCDE plan, which provided a patient centered framework from which to deliver troubling news to patients and families. At the heart of this plan was the creation of a safe environment, the demonstration of timely communication skills, and the display of empathy on the physician's part. Careful consideration of the doctor's own reactions to death and dying also played an important role. A close review of the five tenets of this plan indicates the relevance of Rabow and McPhee's strategy today. The patient base in our nation and state continues to be older, on average, and physicians are faced with numerous patients who have terminal illness. A constructive plan with specific ideas for breaking bad news can help physicians effectively navigate this difficult task.

Attention-deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioural disorder of youth and is estimated to affect ∼4% of school-age children. Although medication is the most common and efficacious treatment for ADHD, some experts believe that multimodal treatment strategies help children improve symptoms more than medicine alone. Psychoeducational strategies focus on educating youth and families about a given disorder. This study compared youth who participated with their parents in a five-session, one-hour psychoeducational group at a family medicine clinic and those who received customary treatment and were on a waiting list for the intervention. Findings of youth behaviour from parent and teacher perspectives were compared at the outset of the group and one month after group completion using the Vanderbilt scales. Results revealed that youth in both conditions improved over the two months of the study from the parent perspective in terms of all ADHD symptoms (e.g. inattention, hyperactivity/impulsivity) and in terms of school functioning. However, no gains were made in youth functioning or ADHD behaviour from the teacher perspective. Youth in the treatment group made modest gains in school performance from the parent perspective when compared with youth in the control condition. The results suggest that parents of ADHD youth should be involved in the treatment process to maximise the likelihood of improvement. Psychoeducational groups can be of modest benefit to help educate parents and youth regarding the challenges of ADHD management.

Research ArticleOpen AccessOne slick trick: building a better biolubricant. Scott Fields Scott Fields Search for more papers by this author Published:1 September 2003https://doi.org/10.1289/ehp.111-a654Cited by:1AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit FiguresReferencesRelatedDetailsCited by Leveneur S, Zheng J, Taouk B, Burel F, Wärnå J and Salmi T (2014) Interaction of thermal and kinetic parameters for a liquid–liquid reaction system: Application to vegetable oils epoxidation by peroxycarboxylic acid, Journal of the Taiwan Institute of Chemical Engineers, 10.1016/j.jtice.2014.01.015, 45:4, (1449-1458), Online publication date: 1-Jul-2014. Vol. 111, No. 12 September 2003Metrics About Article Metrics Publication History Originally published1 September 2003Published in print1 September 2003 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.