Risk assessment and suicide prevention in primary care

General practitioners (GPs) are assumed to occupy an important position in the prevention of suicide through the introduction of risk assessment techniques commonly used in psychiatric practice. Despite this theoretical role for primary care services, it remains unclear how frequently GPs implement risk assessment in patients who may be vulnerable to suicide. To address this, a retrospective survey of probable suicides was conducted within a primary care setting utilizing a questionnaire of GPs who had experienced a patient suicide and was augmented by hospital and coroners' records. 85% of questionnaires were returned and 61 deaths were adjudged as suicides during the year long census period. 75% of suicides were male and 54% were aged under 35.28% were in contact with psychiatric services prior to death, although 60% had some diagnosis of mental disorder. GPs had little knowledge of a patient's life circumstances in up to half of cases. Recording of risk assessment occurred in 38% of subjects, was positively associated with prior psychiatric contact (p = 0.001) but negatively associated with presence of physical illness (p = 0.004), older patient age (p = 0.04), and GPs length in practice (p = 0.05). One GP felt their suicide case was preventable. The low rate of risk assessment and limited knowledge of patient lifestyle point to the need for active engagement of GPs in future suicide prevention strategies and should influence the content of training programs in primary care.     

Market-based incentives and residential municipal solid waste

Coalitions of free-marketeers, politicians, and environmentalists increasingly are turning to the use of market-based incentives in formulating environmental policy. One promising application of market-based incentives is in the management of residential municipal solid waste. This article focuses on unit-based pricing programs established in conjunction with community recycling programs. Using data gathered through telephone and mail surveys of 21 cities, we demonstrate the strong potential for unit pricing to improve the efficiency of residential solid waste management.     

Knowledge and attitudes about AIDS: A comparison of public high school students,incarcerated delinquents,and emotionally disturbed adolescents

This study compared AIDS knowledge and attitudes in public high school students (N=167), incarcerated delinquents (N=166), and emotionally disturbed (SED) adolescents (N=151). The response measure was a 50-item Acquired Immunodeficiency Syndrome (AIDS) questionnaire that was previously used by Bell et al., in their 1991 study of learning disabled adolescents. Although AIDS knowledge was moderately high in all three groups, widespread misunderstandings about disease transmission and awareness of high-risk groups and practices were noted. Knowledge scores were significantly higher in the public school sample than in the SED adolescents; moreover, they tended to be slightly higher (p<0.10) than the delinquent group as well. Teenagers with the severest emotional problems were by far the least informed. Age and race were also predictive of AIDS knowledge. Other results showed that delinquents were more permissive in their attitudes about sex, more inclined to disdain safe sex practices, and more likely to feel threatened by high-risk groups as well as powerless to protect themselves against AIDS. Generally speaking, the findings extend the work of other investigators on the needs for AIDS education in adolescents. The need is especially urgent in delinquent and emotionally disturbed youth who may require a more comprehensive intervention because of their greater knowledge deficits, propensity for high-risk practices, and tendency to deny or underestimate their own vulnerability.Received Ph.D. in clinical psychology from the University of Utah in Salt Lake City. Research interests include health behavior change and the treatment of anxiety and habit disorders. To whom correspondence should be addressed.Received M.A. degree in psychology from the University of the Pacific. Research interests include health behavior change and medical epidemiology.Received Ph.D. in psychology from the University of Auckland, Auckland, New Zealand. Research interests are in child and adolescent psychiatry and the delivery of mental health services.Received Ph.D. in biostatistics from the Medical College of Virginia. Research interests are in general linear models.     

Developing economics expertise for the evaluation of primary health care

Given that government budgets are increasingly stretched in the face of competing demands, there is a pressing need for evidence on the costs and benefits of public sector investments. Nowhere is this need greater than in the health field, where the benefits of programmes are typically difficult to measure. Within the health sector a key area of interest is primary health care, which is generally regarded as a central function and the most important means by which the health of the population can be improved. This paper reports the results of a recent survey of Commonwealth countries which sought to establish the extent of economic evaluation of PHC programmes, the impact on decision-making and the level of health economics expertise available in Third World countries. Based on the results of the survey, suggestions are made for improving the commissioning and conduct of economic evaluations, for interpreting and implementing evaluation results, and for developing government expertise in economic evaluation.     

The social context of adolescent self-esteem

The global self-esteem of adolescents was examined in relation to two aspects of their daily lives: (a) the perceived quality of their relationships with parents and peers; and (b) their self-evaluation in the areas of school, popularity, and athletics. The quality of relationships with parents made significant contributions to the explained variance in self-esteem of both boys and girls. The quality of peer relationships made a significant additional contribution for girls but not boys. The importance of parent and peer relationships to self-esteem did not vary as a function of age for either sex. Self-evaluation of popularity was related to girls' global self-esteem, while evaluation of school performance was more important for boys.Received her Ph.D. from George Peabody College. Research interests include adolescent stress and coping, and parent-child relationships.Received his M.D. from Medical College of Georgia. Research interests include stress, eating disorders, and pregnancy in adolescents.