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In brief: We assessed life events, depression, and general well-being (health concerns, energy, life satisfaction, cheerfulness, tension, and emotional control) in 73 members of the US Alpine Ski Team. We compared these psychological factors with subsequent surveys of general health, illness, and athletic performance and found that psychological status (especially general well-being) was associated with subsequent health problems, injuries, and performance levels. These findings indicate that coaches and sports medicine specialists must be sensitive to psychological disorders in elite athletes and provide appropriate clinical assessment and treatment.

This study investigates the efficacy of an intensive, integrated approach to stress reduction and coping enhancement directed towards an educated, upper level management population. Ninety-five US governmental senior managers participated in a 35-h stress management retreat held over a 3.5-day period. The retreat combined didactic and experiential activities that were designed to increase participants' knowledge of stress liabilities and coping skills. Participants were encouraged to make positive lifestyle changes and to create specific action plans for the year following the workshop. Evaluations of participant satisfaction were completed at the close of the workshop. Eighty-three participants completed baseline and follow-up Stress and Coping Inventory (SCI) assessments in order to identify durable changes in these measures. Across 10 months, participants showed significant improvements in their overall Global Balance scores, psychological symptoms, depression symptoms, and all major coping scales, including Health Habits, Social Support, Responses to Stress and Life Satisfactions. Therefore, an intensive, multifaceted approach to stress intervention is a viable option for encouraging sustained behavioural change. Copyright © 2003 John Wiley & Sons, Ltd.

Objective The purpose of this study was to determine if a novel workplace stress management program, delivered either face-to-face or by self-help, would reduce illness and health services utilization among participants. Methods Five hundred one volunteers were randomly allocated to one of three groups: full intervention, which received assessment and personalized self-study feedback and was offered six face-to-face, small-group sessions; partial intervention, a self-help group that received assessment and personalized feedback by mail; and a wait-list control group. All participants completed questionnaires for stress, anxiety, and coping at the start of the study and 6 and 12 months later. Health reports were completed at 0, 3, 6, 9, and 12 months. A subsample of subjects who subscribed to a single health maintenance organization provided objectively recorded doctor visit data across the study year. Results All three groups reported significant improvement in their stress, anxiety, and coping across the year. Full intervention participants showed a more rapid reduction in negative responses to stress than did participants from the other groups. Full-intervention subjects also reported fewer days of illness than subjects in the other groups. Objectively measured physician visits showed a large (34%) reduction in healthcare utilization for full intervention subjects in the HMO subsample. Conclusions These results indicated that a work-site program that focuses on stress, anxiety, and coping measurement along with small-group educational intervention can significantly reduce illness and healthcare utilization.

Most research studies of stress and coping in a person's life utilize only one or two measures. As scientists, therefore, we become accustomed to seeing these topics in a limited perspective. As health care practitioners, however, we profit from a broader view of these fields. Practitioners of health promotion strive to alert patients and clients to several areas of life adjustment pertinent to health and disease. The Stress and Coping Inventory (SCI) was designed for this kind of health promotion, primarily as an educational instrument and secondarily as a research tool. Reliability testing, using Cronbach alpha correlations, was performed utilizing a sample of 1772 individuals. Intercorrelations run between SCI stress and coping indicators were all in the predicted direction and several were at moderately high orders of magnitude. Analysis of variance was carried out for stress and coping measures according to subjects' reports of recent health problems. Finally, stepwise multiple regression analysis was done, including validation, cross-validation. Copyright © 2000 John Wiley & Sons, Ltd.

This study examined the prevalence and use patterns of alcohol, nicotine, and other drugs in a university ambulatory clinic. A total of 149 patients sampled during a 3-month period was asked to fill out a self-report questionnaire regarding substance use. The questionnaire included the CAGE, the AUDIT, and the T-ACE instruments. Subjects had a mean age of 35 years, were 84% Caucasian, 60% unemployed, and 80% female. Based on CAGE and T-ACE scores, 13 and 25% of the subjects would be screened for possible alcoholism, respectively. The AUDIT revealed a prevalence rate of between 15 and 31% for early problematic drinking. Forty-six percent of the sample reported current use of nicotine. There is a definite overlap between nicotine and other substance use, with smokers representing 60 and 61% of those positively screened by the CAGE and the AUDIT, respectively. Other drug use was highest for marijuana (8.7%), followed by cocaine (4.7%). These prevalence rates validate the need to provide substance abuse training for staff in family practice settings. Primary care physicians may affect both licit and illicit drug use by screening and intervening with gateway drug use such as tobacco and alcohol.

Alcohol, tobacco, and other drug abuse (ATODA) prevalence and use patterns were examined in a university-based ambulatory clinic. Anonymous and confidential questionnaires, interviews, and medical record reviews were conducted with a sample of 139 women. Participants tended to be young (average age was 23 years old), unemployed (93%), and never married (55%). The average participant was 20 weeks pregnant and had sought care at 14.9 weeks. Thirty-eight percent were smokers, with 21.3 and 8.8% reporting use of alcohol or other drugs during pregnancy, respectively. Less than a quarter recalled being asked by their physicians or the clinic staff about alcohol and other drug use. Slightly more recalled being asked about tobacco (25.7%) and nutritional habits (31.6%). Assessment of ATODA issues is difficult with this population, where fear of prosecution may augment the standard barriers of denial and stigmatization. Nevertheless, it is clear that perinatal substance abuse requires more effective education and training in brief assessment and intervention strategies for ambulatory clinic staff as well as community treatment linkages.

Little evidence exists to guide the selection of methods for teaching clinical diagnosis.To compare the efficacy, student preference, and cost of a Web-based (WB) program versus a standardized patient (SP) encounter for teaching clinical diagnosis skills to 2nd-year medical students.Randomized, controlled, crossover study comparing WB versus SP-based teaching for the clinical diagnosis of abdominal pain and headache. Outcome measures were performance on a 2-case SP examination (scored on the basis of a checklist completed by a faculty observer and an objective score on a postencounter subjective-objective assessment plan [SOAP] note), format preferences as assessed by end-of-course evaluations, and cost.Thirty students consented to participate. WB and SP training produced similar scores on both the Abdominal Pain checklist (66% vs. 62%; p = .17) and Headache checklist (56% vs. 63%; p = .07). WB training produced a higher score on the Abdominal Pain SOAP note (69% vs. 47%; p = .006), but not the Headache SOAP note (69% vs. 67%; p = .85). Students rated the SP format higher than the WB format on all 7 preference measures. Start-up costs were estimated at 2,190 dollars for the SP format and 2,250 dollars for the WB format. Ongoing costs per case per student were estimated to be 45 dollars for the SP format and 30 dollars for the WB format.WB and SP learning outcomes were comparable, but students preferred the SP format. Start-up costs were comparable, but the ongoing costs of the WB format were less expensive, suggesting that WB teaching may be a viable strategy.

Background: A school-wide nutrition program was established in 1982 and a required medical nutrition course (MNC) was established in 1985 at the University of Nevada School of Medicine. Emphasis was placed on developing an integrated curriculum and on using innovative methods to incorporate nutrition into the existing curriculum. Objective: The objective of this review was to establish a baseline and make positive curricular changes to comply with the recommendations of the Liaison Committee on Medical Education for accreditation. The MNC and the nutrition curriculum were evaluated as part of this 3-y comprehensive, school-wide evaluation process. Design: The MNC was invited for review (December 2004) because of its position in the curriculum (first year), special content and methods, and relation to other courses. A review team, which consisted of the Assistant Dean for Medical Education (who chaired the team), a curriculum coordinator, faculty representatives, and a medical student, was appointed. The MNC coordinator prepared a review book that included the requested documentation. The initial 3-h review meeting culminated in a formal evaluation and recommendations. Follow-up meetings at 1 mo and 1 y were scheduled. Results: The review was a positive process that reaffirmed the uniqueness of the nutrition program at the University. It supported the MNC as an important part of the required curriculum. Recommendations included use of the Web, encouragement to identify new opportunities with interested faculty, and a structure to further integrate and align nutrition into existing courses. Conclusions: A positive, proactive review process supports the importance of nutrition in the medical school curriculum and encourages further integration.

Little is known about physician ability to utilize Boolean search skills to access information.Determine the proficiency of medical students and practicing physicians to identify efficient Boolean phrases.Experiential survey and multiple-choice questions administered to 49 4th-year medical students and 42 practicing physicians. Subjects identified the best answer or correctly ranked 3 Boolean search phrase options.Practicing physicians identified the single best query phrase significantly more often than did medical students (85.7% vs. 75.0%, p0.001), and both groups had significantly more difficulty correctly rank-ordering the queries (students, 75% vs. 54%, p0.001; practitioners, 85.7% vs. 57.1%, p.04). Only recent MEDLINE use was an independent predictor of accuracy in both groups.Students and physicians demonstrated deficiencies in identifying optimal Boolean phrases. Although formal instruction has not demonstrated clear improvement in skills, more creative teaching of Boolean search techniques should be undertaken and tested.

Most medical students in the United States receive their clinical psychiatry training in community facilities with varied populations, clinical orientations and management systems. Given a substantial diversity in training sites available to the University of Nevada School of Medicine, we wondered if all of our students were learning the basic principles of psychiatry and if there were any differences based on placement. We analyzed outcomes of 139 students assigned to five different facilities. We concluded, based on a statistical analysis of a number of evaluation techniques, that our students did indeed meet the objectives of the educational experience without major differences.

Although attitudinal objectives in medical education about alcohol and drug misuse are important, adequate instruments for measuring the achievement of such objectives have been lacking. The development of a standardized Substance Abuse Attitude Survey (SAAS) is described. Multiple administrations and factor analyses selected and refined the item pool of the final scale. Five factors were derived from tests completed by 324 noncriterion clinicians: Permissiveness, Treatment Intervention, Nonstereotypes, Treatment Optimism and Nonmoralism. The factor structure was found to be internally consistent over repeated administrations. Validation was obtained by scoring surveys completed by 116 criterion clinicians experienced in treating patients who misuse alcohol and other drugs. The criterion clinicians scored significantly higher than the noncriterion clinicians on the Treatment Intervention and Treatment Optimism factors. The SAAS has been well accepted by medical students and practicing physicians. It has proven useful in developing attitudinal objectives, measuring achievement of these objectives and modifying teaching approaches in both undergraduate and continuing medical education.

From 1978 through 1982, pretests and posttests of second-year medical students' attitudes toward substance abuse and its treatment showed that positive attitude change could be achieved during a substance abuse course. When the course was scheduled in competition with demanding basic science courses, however, the students' attitudes did not become as positive as or became more negative than when the course was part of a less demanding schedule. The course used lectures and reading assignments to provide information on substance abuse and used patient contact to change attitudes toward substance abusers and treatment. Emphasis was placed on patient management problems and small-group discussions. The changes in the students' attitudes are assumed by the authors to be positive, but the link between these attitudes and good clinical practice has not been demonstrated.

In order to examine variables that mediate susceptibility to emotional appeals, 80 Ss received a positive or negative appeal concerning a little-known country. In addition, one-half of the Ss also received neutral information about the attitude object prior to the appeal. Results of a 2 by 2 by 2 analysis of variance (Positive Appeal vs Negative Appeal by Prior Information vs No Prior Information by Favorable Initial Attitude vs Unfavorable Initial Attitude) showed two significant interactions. First, negative appeals effected more change among Ss with initially favorable attitudes (p