Climate and human mortality in Virginia, 2005-2020.

Using an extensive database of every resident death in Virginia from 2005 to 2020, climate-mortality relationships are examined for 12 climatically homogeneous regions within the Commonwealth. Each region is represented by a first-order weather station from which archived temperature and humidity data are used to generate a variety of biometeorologically relevant indices. Using these indices and other variables (such as air quality and heat and cold waves), daily mortality and climate relationships are modeled for each region over a 21-day lag period utilizing generalized additive models and distributed lag non-linear models.

A day surgery admissions pathway for children and young people with learning disabilities.

Following feedback from parents and carers, a new pathway was developed by staff in the paediatric day surgery unit of a hospital in England for admitting children and young people with learning disabilities, some of whom are autistic. This article describes the All About Me pathway, which supports individualised admission planning and uses an interdisciplinary approach to enable multiple examinations or procedures to be completed under a single anaesthetic. The authors explain how the All About Me team works with families, schools and caregivers to gain a greater understanding of each child and young person.

Anatomical localisation of the maxillary nerve with the use of computed tomography to aid nerve block placement in dogs.

Background: The maxillary block is a commonly used anaesthetic technique in dogs; however, no universal recommendations for the best method to perform this block exist. Differences between using this block in brachycephalic and non-brachycephalic breeds have not been examined. This study compared the position of the maxillary nerve using CT in brachycephalic and non-brachycephalic dogs.

Description of a novel ultrasound guided peribulbar block in horses: a cadaveric study.

Background: Standing surgery in horses combining intravenous sedatives, analgesics and local anaesthesia is becoming more popular. Ultrasound guided (USG) peribulbar nerve block (PB) has been described in dogs and humans for facial and ocular surgery, reducing the risk of complications retrobulbar nerve block (RB).

Objective: To describe a technique for USG PB in horse cadavers.

Vascular ultrasonographic findings in canine patients with clinically diagnosed phlebitis.

Peripheral vein phlebitis (inflammation) is a relatively frequent complication in dogs, however, published information on the ultrasonographic characteristics is currently lacking. This prospective, observational study describes the ultrasound (US) characteristics of normal canine cephalic veins, and veins with clinical phlebitis. Correlations among US findings and between US findings versus time that the intravenous catheter was in place were investigated.

Postoperative respiratory effects of intravenous fentanyl compared to intravenous methadone in dogs following spinal surgery.

Objective: To evaluate the 24-hour postoperative respiratory effects of either intravenous fentanyl administered as a constant rate infusion or boluses of methadone, in dogs following spinal surgery, assessed by serial arterial blood gas analyses.

Study Design: Prospective, randomized clinical study.

Animals: Thirty-two healthy dogs (American Society of Anesthesiologists I/II) anaesthetized for elective caudal thoracic and/or lumbar decompression spinal surgery.

Miniature swine model of phototoxicity testing.

Background/purpose: This study determined the threshold doses for 'solar erythema' and for phototoxic responses to 8-methoxypsoralen (8-MOP) in white skin Hanford and grey skin Yucatan miniature swine.

Methods: For threshold erythema determinations, the UVR exposures included both UVA (315-400 nm) and UVB (290-315 nm) radiation by positioning one fluorescent 'sunlamp' among 10 'PUVA' lamps. With this configuration the UVR exposures ranged from 0.

Telepsychiatry appointments in a continuing care setting: kept, cancelled and no-shows.

We reviewed the appointment data for a psychiatry service in California that provided consultations and also therapy through telepsychiatry. Over an 18-month period, there were 7523 telepsychiatry appointments and 115,148 conventional (face-to-face) appointments. A higher proportion of the telepsychiatry appointments was kept (92% telepsychiatry vs.

Teaching psychiatry in primary care residencies: do training directors of primary care and psychiatry see eye to eye?

Objective: This study compares the views of psychiatry residency training directors about psychiatry and mental health training in the primary care programs in their institutions with those of the primary care residency training directors.

Methods: A 16-item questionnaire surveying specific areas of training and perceived adequacy of current teaching was distributed to 1,544 U.S.

A proposal for a new multiaxial model of psychiatric diagnosis. A continuum-based patient model derived from evolutionary developmental gene-environment interaction.

Background/aims: To review recent genetic and neuroscientific research on psychiatric syndromes based on the current diagnostic scheme, and develop a better-fitting multiaxial patient-oriented diagnostic model.

Methods: DSM I, published in 1952, considered psychiatric illnesses as reactions or extremes of adaptations of the patient's personality to stressful environmental demands. Personality itself was determined by constitution and psychodynamic development.

Mental health and psychiatry training in primary care residency programs. Part II. What skills and diagnoses are taught, how adequate, and what affects training directors' satisfaction?

Objective: The purpose of this study is to describe the psychiatric skills and diagnostic categories taught in primary care training programs, their adequacy, the perceived needs and desires for curriculum enhancement and the factors affecting training directors' satisfaction.

Method: All 1365 directors of accredited residency training programs in Internal Medicine (IM), Family Practice (FP), Obstetrics and Gynecology (Ob/Gyn), Pediatrics (Peds) and psychiatry received a 16-item anonymous questionnaire about psychiatry training in their program. Responses to the questionnaire to items concerning the skills and diagnostic categories taught, assessment of adequacy of teaching and desires for curriculum enhancement for specific skills and diagnostic categories were analyzed.

Mental health and psychiatry training in primary care residency programs. Part I. Who teaches, where, when and how satisfied?

Objective: Some 40% of patients treated by primary care physicians have significant mental health problems. Only about half eventually receive mental health care, usually by the primary care physicians, often inadequately. Recently, there has been an increased attempt to incorporate psychiatry in primary care training programs.

Repressive/defensive coping, endogenous opioids and health: how a life so perfect can make you sick.

Hyperactivity of endogenous opioid systems has been postulated to mediate the associations between defensive/repressive coping styles, enhanced stress responsivity, and reduced immunocompetence. Study 1 examined whether repressive/defensive coping would be associated with greater sensitivity to opioid antagonism. Judgments of the painfulness of ascending series of electrocutaneous stimulation applied to the forearm were determined before and after the administration of naloxone and placebo in 38 men and 42 women.

Physical factors affecting psychiatric condition. A proposal for DSM-IV.

A new diagnostic category, "Physical Factors Affecting Psychiatric Condition," is proposed for inclusion in the DSM-IV. In addition, there should be a new category called "Chronic Adjustment Disorder." Psychiatric syndromes meeting Axis I or Axis II criteria that arise as an emotional reaction to a chronic or episodic physical illness or disability should be subsumed under the diagnosis of "Physical Factors Affecting Psychiatric Condition--Specific Axis I or II syndrome.

The relationship between repressive and defensive coping styles and monocyte, eosinophile, and serum glucose levels: support for the opioid peptide hypothesis of repression.

The opioid peptide hypothesis of repression (1) predicts that repressive coping is associated with increased functional endorphin levels in the brain, which can result in decreased immunocompetence and hyperglycemia. In a random sample of 312 patients seen at a Yale Medical School outpatient clinic, significant main effects of coping style were found for monocyte and eosinophile counts, serum glucose levels, and self-reports of medication allergies. Specifically, repressive and defensive high-anxious patients demonstrated significantly decreased monocyte counts.

Multidisciplinary teams in consultation-liaison psychiatry: the Yale model.

The consultation-liaison service at Yale features integrated teams of psychiatrists, social workers, and clinical nurse specialists working together in both consultation and outpatient settings. The model is based on the tenets that (1) comprehensive evaluation of patients is essential for effective treatment; (2) role definition is necessary for specific disciplines, including the definition of overlapping and separate areas of expertise and practice. The multidisciplinary teams are coordinated by a psychiatric resident, who is supervised by an attending psychiatrist.

Psychological predictors of survival in cancer patients undergoing radiation therapy.

In a prospective study to identify psychological factors affecting survival in cancer patients receiving radiation therapy, 101 consecutive patients were evaluated for anxiety, depression, and perception of the seriousness of the condition. In 3 years, the survivors were compared to the nonsurvivors. The survivors had significantly higher mean trait anxiety (p less than 0.

Comparison of theoretically oriented and patient-oriented behavioral science courses.

Effective teaching of medical behavioral science is an important challenge for psychiatrists. Two behavioral science courses taught at different times at the Yale University School of Medicine are described: a theoretically oriented course emphasizing symbolic function, primary source reading, and conceptual thinking and a patient-oriented course emphasizing the relevance of behavioral science to the practice of medicine, taught primarily by consultation-liaison psychiatrists. Students' evaluations of the two courses during the fifth year each course was taught were compared.

Skin conductance changes and psychotherapeutic content in the treatment of a phobic patient.

This study examined the relationship between skin conductance response (SCR) and psychotherapeutic content in a single case study. Four SCR conditions of one minute's duration each, reflecting maximal increase (amplitude) and least amount of change as well as one-minute periods preceding these criterion conditions, were measured for each psychotherapy session across 12 consecutive sessions. Psychotherapeutic content corresponding to these SCR conditions was evaluated according to 14 categories by five judges.

Panic-induced elevation of plasma MHPG levels in phobic-anxious patients. Effects of clonidine and imipramine.

Six subjects with the phobic-anxiety syndrome were treated in a controlled, crossover trial of clonidine hydrochloride v imipramine hydrochloride for periods of four weeks each. During each drug trial and during baseline placebo treatment, each patient exposed himself or herself to a situation that previously elicited panic attacks. Self-rated anxiety and plasma levels of 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) were measured to study the effect of the drug treatments on noradrenergic activity and anxiety.

DSM III and consultation-liaison psychiatry: toward a comprehensive medical model of the patient.

The descriptive and multiaxial approaches in DSM III encourage comprehensive conceptualization of the patient. The use of explicit criteria for diagnosing syndromes facilitates communication between psychiatry and general medicine. The DSM III category Psychological Factors Affecting Physical Condition should be further elaborated into (a) Psychiatric Factors Affecting Physical Condition, and (b) Physical Condition Affecting Psychiatric Disorder.

Comment: the role of psychiatry in medicine.

Psychiatry shares with the rest of medicine all basic goals, assumptions, and approaches as well as many techniques. Any apparent "differences in approach" between psychiatry and general medicine arise from a confusion between the essentials and the specialized techniques and procedures developed in psychiatry. The educational task of psychiatry--to integrate relevant knowledge and skills from the behavioral sciences with the biological sciences and to operationalize a comprehensive approach to patient care--can be accomplished by the general psychiatrist through consultation and collaborative care of patients.