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One of the most wellknown psychological tools is the Rorschach Inkblot Test. A viewer looks at ten inkblots, one at a time, and describes what they see. The rationale behind this test is the idea that certain aspects of the subjects personality will be exposed as they are interpreting the images, allowing for the possible diagnosis of various psychological disorders. However, does the inkblot really reveal all? Psychological Science in the Public Interest, a journal of the Association for Psychological Science, published an exhaustive review of all data on the Rorschach (and other similar “projective” tests) in 2000. Such metaanalyses are major undertakings, so although this report is a few years old, it remains the most definitive word on the Rorschach. According to authors Scott O. Lilienfeld of Emory University, James M. Wood of University of Texas at El Paso, and Howard N. Garb of the University of Pittsburgh, despite its popularity, the Rorschach may not be the best diagnostic tool and practitioners need to be cautious in how they use this technique and interpret their results.

The Rorschach Inkblot Test was developed in the 1920s, but was already mired in controversy within 30 years (critics argued that it was not always administered in a standardized way and evidence for its reliability was lacking). However, the Rorschach was revived in the 1970s with the publication of John Exners Comprehensive System (CS), which detailed standards and norms for analyzing results. The CS was credited with providing a concrete, scientific basis for the Rorschach tested and it became widely used in clinical and forensic settings.

Proponents of the CS claimed that it also provided a wealth of information for nonpatient adults and children. However, critics of this system argue that the norms established by CS are out of date and based on small sample sizes. Furthermore, the CS norms are not representative of the population and actually classify a portion of normal subjects as having pathological tendencies. Many studies have also called into question the scoring reliability of the CS; that is, a number of experiments have shown that two practitioners will score one subject very differently using the CS method. The authors observe that “disagreements can have particularly serious implications if the test results are used to reach important clinical or legal recommendations.”

In addition, some studies suggest that there may be a cultural bias associated with the CS. Research has shown that Blacks, Hispanics, and Native Americans score differently on a number of variables in the CS compared to White Americans. The authors note that “similar discrepancies have been reported for CS scores in Central and South American countries as well as in several European countries.” These findings suggest that any CS data acquired from various racial and cultural groups should be interpreted with extreme caution.

The authors acknowledge that not all the news concerning the Rorschach Inkblot Test is bad There is evidence that this tool may be useful in identifying patients with schizophrenia, bipolar disorder, and borderline personality disorder. They note, however, that the Rorschach has not been shown to be related to Major Depressive Disorder, Antisocial Personality Disorders, or Posttraumatic Stress Disorder.

Overall, the authors suggest that due to the inconsistent literature on the Rorschach Inkblot Test and other related psychological tools, practitioners should be very selective when they use these assessments and use them in ways which have strong empirical support. “Whenever possible,” the authors conclude, “forensic and clinical evaluations should be based on more dependable assessment techniques, such as structured psychiatric interviews and wellvalidated selfreport indexes.”

Source
Barbara Isanski

Around one in five young people in the U.S. have a current mental, emotional, or behavioral disorder. About half of all adults with mental disorders recalled that their disorders began by their midteens and threequarters by their mid20s. Early onset of mental health problems have been associated with poor outcomes such as failure to complete high school, increased risk for psychiatric and substance problems, and teen pregnancy.

A new article by Mary E. Evans, RN, PhD, FAAN, published in the Journal of Child and Adolescent Psychiatric Nursing assesses the recently released government report on preventing these disorders among young people. Dr. Evans paper concludes that using certain interventional programs in schools, communities and health care settings, risk for mental illness can be better identified and treated.

The article highlights the fact that specific risk and protective factors have been identified for many disorders. For example, certain thinking and behavioral patterns are risks for the development of depression. Nonspecific factors that increase risk for developing disorders also include poverty, marital conflict, poor peer relations, and community violence. Also, certain neurobiological factors contribute to the development of disorders in youth, but this is also influenced by environmental factors.

A key risk factor for externalizing disorders is aggressive social behavior that begins in early childhood. A number of interventions have been developed to provide training in parenting skills to prevent the development of aggressive and antisocial behavior. In addition, some preventive interventions have targeted specific disorders such as depression and schizophrenia. Cognitive behavioral treatment for highrisk adolescents has lowered the rate of major depressive symptoms. Also, a number of communitybased programs have been shown to be effective in promoting healthy behaviors.

“For all nurses, this report will increase our understanding of risk and protective factors related to the healthy development of children and youth,” Evans concludes.

Mary E. Evans, RN, PhD, FAAN, is affiliated with the College of Nursing, University of South Florida & Institute of Medicine.

Source
Amy Molnar

Diabetes affects nearly 24 million people in the United States. The most widespread form is type 2 diabetes, accounting for about 90 to 95 percent of all diagnosed cases of diabetes, according to the American Diabetes Association (ADA).

The research team at New York Hospital Queens is offering the community a chance to participate in a new type 2 diabetes study. The study, called TINSALT2D (Targeting Inflammation using Salsalate in Type 2 Diabetes), looks at the safety and effectiveness of an investigational medication (similar to aspirin) in the treatment of type 2 diabetes. The study medication has been approved by the U.S. Food and Drug Administration to treat arthritis, but it has not yet been approved for diabetes.

To be eligible for this study, participants must have type 2 diabetes, be between 18 and 75 years old, and be on a stable dose of oral antidiabetic medication and the diabetes is still not well controlled.

The study includes 12 visits to the Lang Research Center over approximately one year. Qualified participants will receive a physical exam and laboratory tests at no cost. Participants will be compensated for their time and effort.

Nationally lauded endocrinologist, Daniel Lorber, M.D., associate director, Eugene and Theresa Lang Research Center for Research and Education at New York Hospital Queens, is the principal investigator of the clinical trial. Last month, Dr. Lorber received the ADAs “Outstanding Physician Clinician Award” for his contributions to the ongoing fight against diabetes.

A clinical trial is a scientific study that evaluates the safety and effectiveness of medical treatments, drugs or devices. These studies are required by the U.S. Food and Drug

Administration for manufacturers to earn approval for new products and new uses for existing products.

Hoag Memorial Hospital Presbyterian announced promising data from a clinical study showing patientspecific cancer vaccines derived from patients own cancer cells and immune cells were well tolerated and resulted in impressive longterm survival rates in patients with metastatic melanoma whose disease had been minimized by other therapies.

The study entitled “Phase II Trial of Dendritic Cells Loaded with Antigens from SelfRenewing, Proliferating Autologous Tumor Cells as PatientSpecific AntiTumor Vaccines in Patients with Metastatic Melanoma,” was published in the June 2009 issue of Cancer Biotherapy and Radiopharmaceuticals and was sponsored by Hoag Hospital Foundation.

“There is continued interest in developing new therapies for melanoma patients with recurrent or distant metastatic disease at the time of diagnosis because there are no systemic therapies that can be relied upon to cure them,” said Robert O. Dillman, M.D., F.A.C.P., executive medical and scientific director at the Hoag Cancer Center and lead investigator for the study. “Patients with metastatic melanoma are at high risk for additional metastases and death.”

During the study, 54 patients with regionally recurrent or distant metastatic melanoma were injected with a vaccine that included each patients own immune cells (dendritic cells) and 500 micrograms of granulocytecolony stimulating factor (GMCSF), an immune stimulator, three times a week and then monthly for five months for a total of up to eight injections. The patients dendritic cells were obtained from their peripheral blood and mixed with a cell culture of the patients own melanoma cells that had been selfrenewing and proliferating in the laboratory. The patientspecific vaccine is designed to stimulate the patients immune system to react against tumor stem cells or early progenitor cells that can create new depots of cancer throughout the body.

Data showed that the projected fiveyear survival rate is 54% at a median follow up of 4.5 years (range 2.4 to 7.4) for the 30 surviving patients. Although not a direct comparison, the results are superior to those observed following vaccination with irradiated tumor cells in 48 melanoma patients in a previous trial (64 vs. 31 months, p=.016). Eight patients in the dendritic cell vaccine study experienced remarkable longterm, progressionfree survival after completing the vaccine therapy, even though they had widely metastatic disease and/or repeated appearance of new metastases despite various therapies. The vaccine treatment was welltolerated, with most patients experiencing mild skin irritation and redness at the injection site.

“The oneyear and projected fiveyear survival rates of 85% and 54%, respectively, are remarkable for melanoma patients with documented metastatic disease,” said Dr. Dillman. “This study is extremely encouraging and shows the potential these types of personalized cancer vaccines have for patients diagnosed with metastatic melanoma.”

Source
Kelly Smith

Health care leaders focused on changing their organizations approach to patient safety and quality will have an opportunity to learn from their peers at The Joint Commission and Joint Commission Resources “2009 Annual Conference on Quality and Patient Safety Explore, Enhance, and Energize Leadership for the Future.” The conference, September 14 to 16, in Rosemont, Ill., is supported by the American Hospital Association, the American Medical Association and the American College of Physicians. Joint Commission Resources (JCR) is a notforprofit affiliate of The Joint Commission.

For the first time, the conference will feature four simultaneous education tracks led by presenters who have firsthand experience with the issues they are discussing. The presenters were chosen based upon their abstract submissions. The education tracks are Leadership, Patient/Family Centered Care, Quality/Patient Safety, and Process Improvement.

This conference is oriented towards patient safety officers, hospital administrators, quality improvement professionals and board leaders. At the conference, attendees will receive takehome tools including many of the forms, flowcharts, reading lists and other resources needed to launch a quality improvement project.

This years keynote speaker is Robert M. Wachter, M.D., professor and associate chairman, Department of Medicine, University of California, San Francisco. Dr. Wachter will speak about the efforts to prevent medical mistakes and what is working and not working a decade after the Institute of Medicines report on medical error “To Err is Human Building a Safer Health System.”

Attendees will also have the opportunity to hear from Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission, and Ann Scott Blouin, Ph.D., R.N., executive vice president, Division of Accreditation and Certification Operations, The Joint Commission.

Jeffrey C. Bauer, Ph.D., partner, Management Consulting Future Practice, ACS Healthcare Solutions, a medical economist and health futurist, will provide a multifaceted overview of technology and explore how each type of technology can be optimally used to produce desired levels of improvement in health care. Bauer will also present specific guidelines for ensuring quality in an efficient and effective manner, and will introduce policy prescriptions for successful reform of health care delivery systems that are consistent with national goals.

The conference will be held at the Donald E. Stephens Convention Center, Rosemont, Ill. This years conference will also offer for the first time an exhibit hall for networking and further educational opportunities. Accommodations will be at the Hyatt Regency OHare. Continuing education credit hours are offered.

The conference is $995 per person or $849 for registration 30 days prior to the conference. A discounted rate of $829 per person is offered for teams of three or more. To register, please call JCR Customer Service at 1.877.223.6866. The registration code is 09065. Additional details and a conference agenda also are available online here.

KP is a genetic skin condition that affects 40 percent of the worlds population, often resulting in patches of dry skin, and little red bumps, on the arms and legs. KP is most prevalent in the teenage years but may continue throughout adulthood. There is no cure for Keratosis Pilaris.(1, 2)

Dr. Alan B. Fleischer, professor and chair of the department of dermatology at Wake Forest University School of Medicine, recommends keeping skin moisturized to help manage the dry skin associated with KP by using products containing lactic acid, such as AmLactin(R) or AmLactin XL(R).

About Keratosis Pilaris

There is no cure for Keratosis Pilaris (KP) and the cause remains unknown, however it tends to run in families.(2) People with KP may experience fleshcolored or red bumps around hair follicles on the upper arms, thighs, buttocks, and cheeks, extremely dry skin and, in some cases, itching.(1,2) It is important to be aware that other medical conditions can mimic KP, so people with these symptoms should visit a doctor to confirm a diagnosis.

Littleredbumps.com and The AmLactin(R) family of moisturizers are not intended to diagnose, treat, cure or prevent any medical condition. Some skin conditions may be worsened by moisturizers, so people should always follow their doctors skin care recommendations.

AmLactin(R)

The AmLactin(R) family of moisturizers are the number one dermatologist and podiatrist recommended brand of moisturizers (1,3,4) and are readily available without a prescription at fine retailers nationwide and online.

UpsherSmith

UpsherSmith Laboratories, Inc. is a rapidlygrowing pharmaceutical company that manufactures and markets both prescription and consumer products. UpsherSmith prides itself on providing safe, effective and economical therapies to the everchallenged healthcare environment.

(1) aad.org/public/publications/pamphlets/skin_dry.html

(2) Nili, A. Keratosis pilaris. September 2008

(3) Rough, Dry skin most recommended moisturizing product. Omnibus Study. Dermatology Times. 2008.

(4) Kloos Donoghue S. Podiatry management annual practice survey. Podiatry Management. February 2009.

It would make sense that teenage mothers have a lot of psychological stress in their lives, but a new study shows that the distress comes before the pregnancy, not because of it.

“Psychological distress does not appear to be caused by teen childbearing, nor does it cause teen childbearing, except apparently among girls from poor households,” said Stefanie Mollborn, Ph.D., an assistant professor of sociology at the Institute of Behavioral Science of the University of Colorado at Boulder.

The study, published in the September issue of the Journal of Health and Social Behavior, used data from two large longterm U.S. surveys that followed thousands of teen girls and women. Participants responded to items on symptoms associated with depression, such as how often they found things that did not usually bother them to be bothersome, how easily they could shake off feeling blue or whether they had trouble concentrating. The researchers did not use the term “depression,” which is a clinical diagnosis.

Only the combination of poverty and existing distress was a good predictor of teen pregnancy.

Previous studies had shown high levels of depression among teen mothers, but nationally representative studies had not examined if distress was present before the pregnancy and stresses of young motherhood.

“Psychologically distressed girls are at risk for teen childbearing and vice versa, even if the two things usually do not cause each other,” Mollborn said. “This could help educators and clinicians identify atrisk adolescents.”

Looking for symptoms of depression or distress should be part of normal health screening for all teenagers, said Diane Merritt, M.D., director of Pediatric and Adolescent Gynecology at the Washington University School of Medicine in St. Louis. “Talking to teenagers about their sexuality and responsible behavior is key,” she said. Responsible behavior would include the use of birth control if the teenager were sexually active.

One of the best ways to prevent teen pregnancy is for teens to have longterm goals and good selfesteem, Merritt added.

High levels of depression have longterm negative consequences for both mothers and children, Mollborn said. The higher levels of psychological distress in women who had teenage pregnancies continued well into adulthood, she added.

Sen. Lindsey Graham (RS.C.) on Wednesday said he intends to vote for Supreme Court nominee Sonia Sotomayor, making him the fifth Republican senator to endorse the nominee, USA Today reports. Meanwhile, Senate Minority Whip Jon Kyl (RAriz.) became the 10th Republican to say that he will vote against her confirmation. During Sotomayors confirmation hearings last week, both Graham and Kyl “grilled her extensively,” USA Today reports (Kiely/Brettschneider, USA Today, 7/23). According to Politico, Republicans privately estimate that Sotomayor could receive upward of 70 votes (Kady, Politico, 7/23). The Senate Judiciary Committee is scheduled to vote on the nomination Tuesday, followed by a full Senate vote late next week or the first week of August (Stanton, Roll Call, 7/22).

According to CQ Today, Grahams support could encourage other conservatives to back Sotomayor (Perine, CQ Today, 7/22). Graham said that Sotomayor “is definitely more liberal” than any Supreme Court nominee a Republican president would have chosen but that she also is “one of the most qualified” nominees in decades. He added, “I do believe that elections have consequences, and its not like we hid from the American people during the campaign that the Supreme Court nomination was at stake. The American people spoke” (USA Today, 7/23). Graham also said that he believes that Sotomayor “follows precedent” and “would not be an activist judge” (CQ Today, 7/22). He continued, “On balance, I do believe that the court will not dramatically change in terms of ideology with her selection,” adding, “On some issues, quite frankly, (she) may be more balanced in her approach” (Hirschfeld Davis, AP/Boston Globe, 7/22).

Kyl said, “Unfortunately, I have not been persuaded that Judge Sotomayor is absolutely committed to setting aside her biases and impartially deciding cases based upon the rule of law,” adding, “And I cannot ignore her unwillingness to answer senators questions straightforwardly” (Politico, 7/23).

Broadcast Coverage

NPRs “All Things Considered” on Wednesday reported on Grahams support of Sotomayor (Shapiro, “All Things Considered,” NPR, 7/22).

Reprinted with kind permission from nationalpartnership.org. You can view the entire Daily Womens Health Policy Report, search the archives, or sign up for email delivery here. The Daily Womens Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

© 2009 The Advisory Board Company. All rights reserved.

The UK will play a leading role in coordinated European action to tackle dementia from.

A new initiative launched by the European Commission has adopted proposals to tackle Alzheimers disease, dementias and other neurodegenerative conditions.

The UK is one of ten countries that will lead research aimed at tackling shared health and social care problems. According to the Commission there are over seven million people with Alzheimers disease and related disorders in Europe and it is predicted that this number will double in the next 20 years.

Todays actions mark new steps both in the Commissions Europe for Patients campaign and the new approach of Joint Programming in research.

Dr Susanne Sorensen, Head of Research, Alzheimers Society says,

Building on successful high impact dementia research, the UK will play a critical role in this initiative, leading the fight to defeat dementia. By uniting to find a cause, cure and fund care, we can galvanise our efforts and offer hope to millions of people. But while Europe strives forward, the UK government still lags behind the US, Germany and France in providing dementia research funding and there is still no specifically targeted dementia research funding. Yesterday the government promised to develop a strategy for investment in dementia research. It must make good on its promises or we will all pay the price.

In an open letter to the government yesterday, 31 leading dementia researchers united to call for a national plan for dementia research and a tripling of current investment.

A research published ahead of print in the Archives of Disease in Childhood reports that every hour of the day children are inactive adds three minutes to the time it takes them to fall asleep.

The study indicates that children who fall asleep faster also sleep for longer. Although, it appears one is not the direct consequence of the other.

Research shows that approximately 16 percent of parents of school aged children report that their child finds it difficult to get to sleep.

There is a connection between poor sleeping patterns in children and inferior school performance. It is also linked to an increased risk of overweight and obesity.

Using an activity monitor (called an actigraph) worn for 24 hours, the authors evaluated the daytime activity and sleep patterns of a representative sample of 591 seven year olds.

They obtained full information on sleep patterns for 519 of the children. They took an average of 26 minutes to fall asleep. This is known as sleep latency, ranging from 13 to 42 minutes (interquartile range).

The parents reported that around one in ten of the children regularly found it difficult to fall asleep quickly. These children took around 15.5 minutes longer to get to sleep.

The children, who were physically active during the day, fell asleep more rapidly than their more sedentary peers. The more vigorous activity they did, the faster they fell asleep.

In addition, every hour of the day spent in sedentary activity increased sleep latency by three minutes.

Shorter sleep latency was also associated to longer duration of sleep. It fell by more than 11 minutes for each additional hour of sleep.

The authors comment these findings will validate what many parents already believe that tiring out a child with plenty of physical activity will increase the likelihood that she or he will sleep well.

They write in conclusion “This study emphasizes the importance of physical activity for children, not only for fitness, cardiovascular health and weight control, but also for sleep.”

“Falling asleep the determinants of sleep latency”
G M Nixon, J M D Thompson, D Y Han,D M O Becroft, P M Clark, E Robinson,K E Waldie, C J Wild, P N Black, E A Mitchell
Online First Arch Dis Child 2009; doi 10.1136/adc.2009.1574453
Arch Dis Child