Managed care and outpatient substance abuse treatment intensity

This study examines the extent to which managed care behavioral controls are associated with treatment intensity in outpatient substance abuse treatment facilities. Data are from the 1995 National Drug Abuse Treatment System Survey, a nationally representative survey that includes over 600 provider organizations with a response rate of 86%. Treatment intensity is measured in three ways: (1) the number of months clients spend in outpatient drug treatment, (2) the number of individual treatment sessions clients receive over the course of treatment, and (3) the number of group treatment sessions clients receive over the course of treatment. After accounting for selection bias and controlling for market, organization, and client characteristics, there is no significant relationship between the scope of managed care oversight and treatment intensity. However, the stringency of managed care oversight activities is negatively associated with the number of individual and group treatment sessions received over the course of treatment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45772/1/11414_2005_Article_BF02287231.pd

Quantum and Nonlinear Optics with Hard X-Rays

With the increasing brilliance of modern synchrotron radiation sources and free-electron lasers, the observation of nonlinear and quantum optical phenomena at x-ray wavelengths has come into reach. Single-photon x-ray detectors with quantum efficiency near unity and photon-number resolving capabilities are commercially available. Consequently, fundamental concepts in quantum optics can now also be studied in the x-ray portion of the electromagnetic spectrum. A key role in theoretical and experimental studies in x-ray quantum optics is played by the nuclear resonances of Mössbauer isotopes, the excitation of which became more and more efficient with increasing spectral flux delivered by these sources. The narrow resonance bandwidth facilitates to probe fundamental aspects of the light-matter interaction. A very sensitive manipulation of this interaction is possible by embedding Mössbauer nuclei in x-ray cavities. This allows one to prepare collective radiative eigenstates which open new avenues to establish concepts of quantum control in the x-ray regime via generation of coherences between nuclear levels. Moreover, the large number of vacuum field modes in the x-ray regime enables one to produce and probe nonclassical states of x-ray radiation and has opened the field of nonlinear x-ray optics

Laughter as the Best Medicine: Exploring Humour-Mediated Health Applications

Despite the physiological and psychological benefits of humour on health, many health applications for aging hold very little humour. We investigate the potential of humour in health for aging, reviewing studies from humour therapy. To show the potential of humour in this domain, we look at the functions of humour and discuss their application to the design of virtual agents. Then, we propose new conceptual designs based on the therapeutic use of humour: agents as comic relief, agent as comic partners, and agents as virtual clowns. We aim to initiate a new research agenda in this domain and stimulate further investigations in the use of humour-mediated technology

Transtorno de humor bipolar: diversas apresentações de uma mesma doença Bipolar mood disorder: different occurrences of the same disease

O presente relato tem por objetivo acompanhar a evolução de um caso que se apresentou como mutismo seletivo e evoluiu para transtorno de humor bipolar e chamar atenção para a diversidade de sintomas possíveis no transtorno de humor. Em geral, o mutismo seletivo tem início na idade pré-escolar, porém os sintomas chamam mais atenção na idade escolar. A importância do diagnóstico e tratamento precoces reside na prevenção das complicações, tais como distúrbios no desenvolvimento social e acadêmico e na auto-estima, além da possibilidade de evolução para outros transtornos de ansiedade. O transtorno de humor bipolar é uma doença mental caracterizada por variações extremas no humor. Na criança, prejudica o crescimento emocional e seu desenvolvimento. É confundido com transtorno de déficit de atenção/hiperatividade e transtornos de comportamento, tais como transtorno de conduta e desafiador opositivo. A paciente do sexo feminino, quando avaliada, estava com 5 anos e 9 meses de idade. Concluiu-se o diagnóstico como mutismo seletivo. Foi indicada psicoterapia, com orientações aos pais e à escola, e iniciado o uso de inibidores seletivos de recaptação da serotonina, com boa resposta aos sintomas de ansiedade, mas passou a apresentar piora significativa do comportamento. Foi levantada a hipótese diagnóstica de transtorno de humor bipolar de início precoce. Medicada com estabilizador, apresentou adequação na terceira medicação e evolução satisfatória. O mutismo seletivo, considerado um transtorno de ansiedade na infância, pode ser pródromo para outros quadros psiquiátricos na infância. Há necessidade que os pediatras, médicos que primeiro acessam essas crianças, assim como os psiquiatras da infância, estejam atentos à riqueza de sintomas que pode dar seguimento ao quadro.<br>The purpose of the present case report is to follow the evolution of a child who presented selective mutism and evolved into bipolar mood disorder, and also to draw attention to the diversity of possible symptoms of mood disorders. In general, selective mutism starts at preschool age, although the symptoms are more evident at school age. The importance of an early diagnosis and treatment lies in the prevention of some complications, such as social and academic development and self-esteem, besides the possibility of the development of other anxiety disorders. Bipolar mood disorder is a mental disease characterized by extreme mood variations. In childhood, it hinders the child's emotional growth and development. Selective mutism is mistaken by attention deficit hyperactivity disorder, and behavioral disorders, such as conduct disorder and oppositional defiance disorder. The present case report is about a female patient evaluated at 5 years and 9 months of age. We concluded the case as being a selective mutism disorder. Not only psychotherapy, with parent and school orientation, but also medication was prescribed. The first prescribed medication was use of selective serotonin reuptake inhibitors with good results regarding anxiety symptoms, although the patient started to present significant deterioration in behavior. Because of that, the diagnostic hypothesis came to be bipolar mood disorder with an early start. The patient presented satisfactory evolution only after given a third option of mood stabilizer medication. Selective mutism, which is an anxiety disorder in childhood, can be prodromus to other psychiatric conditions at the same age. It is necessary for pediatricians, who are the doctors that first assess these children, and also child psychiatrists, to be aware of the wealth of symptoms that can give continuation to the condition