Psychiatric correlates of medical care costs among veterans receiving mental health care

Research on increased medical care costs associated with posttraumatic sequelae has focused on posttraumatic stress disorder (PTSD). However, the provisional diagnosis of Disorders of Extreme Stress Not Otherwise Specified (DESNOS) encompasses broader trauma-related difficulties and may be uniquely related to medical costs. We investigated whether DESNOS severity was associated with greater nonmental health medical care costs in veterans receiving mental health care. Participants were 106 men and 105 women receiving VA outpatient mental health treatment. A standardized interview assessed DESNOS severity. The dependent variables consisted of primary and specialty medical treatment costs. Sequential zero-inflated negative binomial regression was used to evaluate the variance in medical costs accounted for by DESNOS severity, controlling for PTSD severity and established predisposing, enabling, and need-based health care factors. Contrary to our hypothesis, in fully adjusted models, DESNOS severity independently added a significant amount of variance to lower specialty medical care costs, whereas PTSD did not consistently account for significant variance in medical care costs. Greater DESNOS severity appears to be associated with lower specialty medical care costs but not primary care costs. These findings may indicate that patients with DESNOS symptoms are at risk for being underreferred for specialty care.     

美国大学的通识教育

生活是一个整体,而非划分为不同的专业。现代社会中的工作、生活都已超越了传统的专业边界,所有的学生都需要通识教育以获得全面发展。美国德克萨斯A&M大学设立的校级核心课程、文学院课程和国际研究课程,对其他大学开展通识教育可能会有参考作用。     

The Bottom Line: The Effect of Written Expert Witness Statements on Juror Verdicts and Information Processing

Mock jurors recruited from jury rolls were either not given written statements of expert witnesses' direct testimony or were provided with such statements before or after the presentation of that testimony. Presentation of the statements before the testimony and cross-examination provided jurors with a schema that allowed them to distinguish more effectively among the claims of four differentially worthy plaintiffs because they processed more probative evidence than other jurors. Jurors in receipt of written statements before the testimony found the evidence to be more comprehensible than other jurors. Jurors provided with written statements following testimony and cross-examination were able to differentiate between the most and least severely injured plaintiffs, whereas jurors not in receipt of any written statements were unable to differentiate among any of the differentially worthy claimants. The limitations of this case management technique and of the study are discussed.     

How the Framework of Implementation Science Guided an Evidence‐Based Dependency Parenting Program Initiative in Florida

In Florida, like most states, many of the parenting programs that are being utilized with families in the dependency system are non‐evidence based, and fail to provide quantifiable data on parent progress during and after completion of the programs. Providing pertinent information in court on parents’ progress in a parenting program, as opposed to simply monitoring attendance, is a growing need voiced by dependency judges and child welfare case management professionals. Clear, reliable information related to parenting skills acquisition and insight can help to ensure that families involved in the child welfare system have access to quality services that improve outcomes for their children. The purpose of this paper is to detail how a statewide initiative to increase the number of Florida circuits providing evidence‐based parenting programs to their clients utilized implementation science to guide their process, and the degree to which the participating circuits achieved full implementation of evidence‐based parenting programs.