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Objective: To identify and empirically investigate the dimensions of leadership in medical education and healthcare professions., Design: A population-based design with a focus group and a survey were used to identify the perceived competencies for effective leadership in medical education., Setting: The focus group, consisting of five experts from three countries (Austria n=1; Germany n=2; Switzerland n=2), was conducted (all masters of medical education), and the survey was sent to health professionals from medical schools and teaching hospitals in six countries (Austria, Canada, Germany, Switzerland, the UK and the USA)., Participants: The participants were educators, physicians, nurses and other health professionals who held academic positions in medical education. A total of 229 completed the survey: 135 (59.0%) women (mean age=50.3 years) and 94 (41.0%) men (mean age=51.0 years)., Measures: A 63-item survey measuring leadership competencies was developed and administered via electronic mail to participants., Results: Exploratory principal component analyses yielded five factors accounting for 51.2% of the variance: (1) social responsibility, (2) innovation, (3) self-management, (4) task management and (5) justice orientation. There were significant differences between physicians and other health professionals on some factors (Wilk's λ=0.93, p<0.01). Social responsibility was rated higher by other health professionals (M=71.09) than by physicians (M=67.12), as was innovation (health professionals M=80.83; physicians M=76.20) and justice orientation (health professionals M=21.27; physicians M=20.46)., Conclusions: The results of the principal component analyses support the theoretical meaningfulness of these factors, their coherence, internal consistency and parsimony in explaining the variance of the data. Although there are some between-group differences, the competencies appear to be stable and coherent.

Context: Few population-based studies have examined the relationship between psychiatric and somatic or biomedical disorders., Objective: We examined the effect of the presence or absence of any psychiatric disorder on somatic or biomedical diagnosis disorder costs. Guided by the Kaiser Permanente and Centers for Disease Control and Prevention Adverse Childhood Experiences (ACE) Study, we examined our administrative data to test if psychiatric disorder is associated with a higher level of somatic disorder., Design: A dataset containing registration data for 205,281 patients younger than age 18 years was randomly selected from administrative data based on these patients never having received any specialized, publicly funded ambulatory, emergency or inpatient admission for treatment of a psychiatric disorder. All physician billing records (8,724,714) from the 16 fiscal years April 1993 to March 2009 were collected and grouped on the basis of presence or absence of any International Classification of Diseases (ICD) psychiatric disorder., Main Outcome Measures: We compared 2 groups (with or without any psychiatric disorder: dependent variable) on the cumulative 16-year mean cost for somatic (biomedical, nonpsychiatric) ICD diagnoses (independent variable)., Results: Billing costs related to somatic and biomedical disorders (nonpsychiatric costs) were 1.8 times greater for those with psychiatric disorders than for those without psychiatric disorders. Somatic costs peaked before the age of 6 years and remained higher than the groupings without psychiatric disorders in each age range., Conclusion: In support of the ACE study, ICD psychiatric disorders (as an index of developmental adversity) are associated with substantially greater ICD somatic disorders. The findings have implications for health care practice.

Objective: This study tested a structural model, examining the relationship between a latent variable termed demoralization and measured variables (anxiety, depression and hopelessness) in a community sample of Canadian youth., Methods: The combined sample consisted of data collected from four independent studies from 2001 to 2005. Nine hundred and seventy one (n=971) participants were high school students (grades 10-12) from three geographic locations: Calgary, Saskatchewan and Lethbridge. Participants completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory-Revised (BDI-II), Beck Hopelessness Scale (BHS), and demographic survey. Structural equation modeling was used for statistical analysis., Results: The analysis revealed that the final model, including depression, anxiety and hopelessness and one latent variable demoralization, fit the data (chi-square value, X(2) (2) = 7.25, p< .001, goodness of fit indices (CFI=0.99, NFI=0.98) and standardized error (0.05). Overall, the findings suggest that close relationships exist among depression, anxiety, hopelessness and demoralization that is stable across demographic variables. Further, the model explains the relationship between sub-clinical anxiety, depression and hopelessness., Conclusion: These findings contribute to a theoretical framework, which has implications for educational and clinical intervention. The present findings will help guide further preventative research on examining demoralization as a precursor to sub-clinical anxiety and depression.

Objective: The 17-item PCS was designed for priority-setting and queue management of children and adolescents referred for mental health services. Here we assess aspects of the validity of the Children's Mental Health (CMH) Priority Criteria Score (PCS), developed by the Western Canada Waiting List Project (WCWL). The PCS was evaluated across clinical settings of increasing acuity and in terms of its relationship to two variables reflecting criteria-related validity and actual wait times., Method: Intake workers completed PCS forms for 497 referrals enrolled for treatment in three clinical areas over approximately two fiscal years. The completion time of the PCS form was estimated in relation to the total referral and screening process. Intake workers completed the PCS items and did not use the total score at the time of intake and form completion to triage or place clients; hence, the PCS was independent of enrollment and placement within the continuum of care. Furthermore, clinicians in the receiving programs had to accept the triage decisions for the PCS to be used in the study analysis., Results: The PCS score was meaningfully related to the measures of criteria-related validity (e.g., clinician perceived urgency, clinician perceived maximum acceptable waiting times) and triage to clinical settings of increasing acuity. There was a significant mean difference in the PCS for those accepted to community, day, or inpatient settings., Conclusions: The PCS appears to be a useful, efficient measure of clinical urgency adequate for use in priority-setting for children waiting for mental health services.

Introduction: There have been various strategies employed to improve the ability of primary care physicians to identify and intervene in the mental health concerns of young children. In this study we assessed community physician needs and ability to identify mental health problems in children less than 6 years of age., Methods: Two surveys were conducted. The purpose of the surveys was to identify the learning needs among primary care physicians and their capacity to serve very young children., Results: Most physicians reported that they did not have enough knowledge and support to detect and manage mental health problems in young children and that they received minimal undergraduate training., Conclusions: Community physicians require primary mental health care support to serve the mental health concerns of young children age 0-6.

Objective: The objective of this study was to examine the occurrence of behavioral contagion among inpatient adolescent psychiatric patients in terms of past self-harm related behaviors. Our goal was to isolate persistent self-harm behavior from self-harm behavior that could be considered truly contagious., Method: We employed 5 years retrospective cohort study design in order to compare the occurrence of self-harm as inpatients among those with and without histories of self-harm behavior., Results: Our results indicate that the spontaneous occurrence of self-harm among inpatients without a history of self-harm is very low. While there appears to be a group that exhibits self-harm as inpatients, the tendency in this group is more towards a reduction of the intensity or a cessation of self-harming behavior., Conclusions: Contagious self-harm does not appear to be a problem among inpatients with long stays on psychiatric treatment units. The overall tendency among inpatient adolescent psychiatric patients, especially those among those with histories of self-harm behavior is away from self-harming behavior.

The purpose of this study was to examine the psychiatric diagnoses of depression made using the structured interview, the Computer-Based Diagnostic Inventory Schedule for Children-Revised (CDISC-R) and diagnoses of depression made by pediatric psychiatrists. One hundred and twenty-two adolescents who were admitted to an inpatient psychiatric treatment unit agreed to participate in the study. All participants completed the CDISC-R structured diagnostic interview and independent measures reflecting depressive symptoms. The admitting pediatric psychiatrists' diagnoses were also recorded. Even though there were more females in the sample, males (n = 38) and females (n = 84) had similar results. The computer-based CDISC-R and physician diagnoses agreed in 76% of the cases. These results were confirmed by the independent measures of depressive symptoms, which were higher for those with diagnoses of depression and lower for those without depression. In the 24% of the cases, where the CDISC-R and physician diagnoses disagreed, the computer-based CDISC-R was more accurate in assigning a diagnosis of depression in terms of the independent measures of depressive symptoms. The CDISC-R, a computer-based diagnostic interview, efficiently and precisely diagnoses depression. This finding indicates that the use of computer-based diagnostic interviews in applied research will provide more objective and precise results, especially in clinical trials. It follows from these findings that computer-based diagnostic interviews could have important clinical applications and play a central role in web-based mental health and Telemedicine by facilitating triage, referral, and monitoring treatment outcomes through remote electronic assessment.

Objective: Referrals to the Bradford (England) Child and Family Psychiatric Clinic were studied over a five-year period with the purpose of comparing native Caucasian and immigrant groups. Punjabi Moslems of Pakistani descent formed a majority of immigrant referrals., Method: This immigrant sample was compared with native Caucasians matched for age and sex., Results: Differences between these groups were found in the rates and sources of referral, together with family composition, diagnosis and adherence to treatment., Conclusion: These results are discussed in terms of the influence of cultural background and gender socialization. This report makes suggestions with respect to service provision and the assessment of individuals from linguistically unassimilated ethnic minorities.

Acetylcholine (ACh) dissolved in seawater and perfused through the isolated gill of the Aplysia californica produced suppression of the gill withdrawal reflex (GWR) evoked by tactile stimulation of the gill. This suppression was reversible upon washout and was blocked by co-perfusion of curare and alpha-bungarotoxin. Co-perfusion of atropine did not block the suppression of the GWR produced by ACh. We concluded that the suppressive effects produced by perfusion of ACh through the gill occur as a result of the action of ACh at the nicotinic-like receptors. The role of ACh suppression in the mediation of gill reflex behaviours is discussed.

The peripheral nervous system (PNS) in the gill of Aplysia plays an important role in the mediation of adaptive gill withdrawal reflex (GWR) behaviors. It has proven difficult to determine whether or not neuronally active agents work directly on PNS neurons, the muscle or both. We have now been able to isolate individual gill muscle fibers in culture and thus begin an analysis of how endogenous neurotransmitters and/or neuromodulators act. We report here that both dopamine and FMRF-amide act directly on gill muscle fibers to cause contractions.

Perfusion of the endogenous neuropeptide, FMRFamide, through the isolated gill of Aplysia facilitated the amplitude of the gill withdrawal reflex (GWR) evoked by tactile stimulation of the gill. The GWR was facilitated in a dose-dependent manner. The facilitation of the GWR produced by FMRFamide perfusion was reversible. In addition to facilitating GWR amplitude, FMRFamide perfusion could also prevent habituation of the reflex. It is hypothesized that FMRFamide may play a role in the peripheral nervous system (PNS) in the gill in the mediation of behavioral state and modulation of adaptive gill behaviors.

Abstract Perfusion of Phe-Met-Arg-Phe-NH(2) (FMRFamide), an endogenous neuropeptide, through the gill of Aplysia significantly potentiates the amplitude of the gill withdrawal reflex evoked by tactile stimulation of the siphon with or without the central nervous system present. The potentiating effect of FMRFamide is reversible with washout. FMRFamide perfusion of the gill also prevented the gill withdrawal reflex from undergoing habituation when the tactile stimulus was presented repeatedly. Rather than habituate, the gill withdrawal reflex increased in amplitude. FMRFamide continued to prevent habituation in the absence of the parietal-visceral ganglion. We hypothesize that FMRFamide plays a role in the mediation of behavioural state primarily by affecting activity in the peripheral nervous system in the gill.