An Evaluation of the Relation Between Distress Tolerance and Posttraumatic Stress within a Trauma-Exposed Sample

The present investigation examined the incremental associations between distress tolerance, or the perceived capacity to tolerate emotional distress, and global posttraumatic stress symptom severity as well as symptom cluster severity, beyond the variance accounted for by number of trauma exposure types and negative affectivity. The sample consisted of 140 adults (72 women; M(age)=25.9, SD=11.1) who endorsed exposure to traumatic life events, as defined by posttraumatic stress disorder diagnostic criterion A (American Psychiatric Association 2000). Participants did not meet diagnostic criteria for current axis I psychopathology. Distress tolerance demonstrated significant incremental associations with global posttraumatic stress symptom severity (p<.01) as well as re-experiencing (p<.05), avoidance (p=.05), and hyperarousal (p<.001) symptom cluster severity. Given the cross-sectional study design, causation cannot be inferred. Theoretical implications and future directions for better understanding associations between distress tolerance and posttraumatic stress are discussed.

Exploring the mediational role of coping motives for marijuana use in terms of the relation between anxiety sensitivity and marijuana dependence

This study evaluated the prediction that coping motives for marijuana use would mediate the relation between anxiety sensitivity and a marijuana dependence diagnosis after controlling for other co-occurring marijuana use motives. Participants were 136 current marijuana users (47.1% women; M(age)= 21.9, SD = 7.2). Results were consistent with a mediational effect, with the relation between anxiety sensitivity and marijuana dependence being explained by the addition of coping motives into the model. These results provide novel information related to the putative explanatory role of coping motives for marijuana use in the relation between anxiety sensitivity and marijuana dependence.

Cognitive-affective characteristics of smokers with and without posttraumatic stress disorder and panic psychopathology

The present study evaluated differences among daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), panic attacks (PA), and no axis I psychopathology (past 6 months) in terms of several cognitive-affective variables implicated in both the onset and maintenance of anxiety psychopathology and cigarette smoking. The sample consisted of 123 daily smokers (62% women: M(age)=29.7, SD=11.9). Compared to the PA and no psychopathology groups, the PTSD group reported significantly higher levels of anxiety sensitivity, discomfort intolerance, negative affectivity, anxious arousal, and anhedonic depression; and, the PTSD group reported significantly lower levels of perceived control over anxiety-related events than the PA group. The PD group, compared to those in the PA and no psychopathology groups, reported significantly higher levels of anxiety sensitivity, negative affectivity, and anxious arousal; and significantly lower levels of perceived control over anxiety-related events. No significant differences were evident between the PTSD and PD groups. Theoretical and clinical implications of the present findings are discussed in terms of smoking and emotional vulnerability.

Anxiety sensitivity and panic reactivity to bodily sensations: relation to quit-day (acute) nicotine withdrawal symptom severity among daily smokers making a self-guided quit attempt

The current investigation explored the main and interactive effects of panic attacks in response to laboratory-induced bodily sensations and anxiety sensitivity in predicting acute nicotine withdrawal symptoms among daily smokers making a self-guided quit attempt. Participants were 99 daily smokers (58% women; M(age) = 28.4 years, SD = 11.7) who completed a battery of questionnaires, a voluntary hyperventilation challenge, and a measure of nicotine withdrawal symptoms 12 hr after making a self-guided quit attempt. Results indicated that the interaction of anxiety sensitivity and panic responsivity to the challenge predicted quit-day nicotine withdrawal symptom severity above and beyond the main effects (p < .05). The form of the interaction indicated that the relationship between postchallenge panic attack status and acute nicotine withdrawal was more robust among individuals who were low in anxiety sensitivity. Individuals who did not experience a panic attack posthyperventilation who were also low in anxiety sensitivity reported the lowest levels of nicotine withdrawal. Results suggest that anxiety sensitivity may be less relevant with regard to acute nicotine withdrawal severity among individuals with panic-related problems.

Reasons for quitting smoking prior to a self-quit attempt among smokers with and without posttraumatic stress disorder or other anxiety/mood psychopathology

The present investigation examined intrinsic and extrinsic reasons for quitting among daily cigarette smokers with posttraumatic stress disorder (PTSD) as compared to clinical daily smokers with other anxiety and mood disorders (AM) and daily smokers with no current Axis I psychopathology (C) prior to a self-guided quit attempt. It was hypothesized that (1) the PTSD group would report greater intrinsic (ie, self-control and health concerns) reasons for quitting smoking, and (2) among those with PTSD, anxiety sensitivity (fear of anxiety; AS) would predict greater intrinsic reasons for quitting smoking. Participants were 143 (58.7% female; M(age) = 29.66 years, SD = 11.88) daily cigarette smokers. Partially consistent with prediction, the PTSD group reported significantly greater self-control intrinsic reasons for quitting, but not health concern intrinsic reasons, than the C group (p < .01). The PTSD group also reported greater immediate reinforcement extrinsic reasons for quitting than the C group (p < .05). The PTSD and AM groups did not significantly differ on any reasons for quitting. Also partially consistent with hypotheses, higher levels of anxiety sensitivity in daily smokers with Axis I psychopathology (both PTSD and AM groups) significantly predicted greater self-control intrinsic reasons for quitting. AS did not significantly predict immediate reinforcement extrinsic reasons for quitting. The current findings suggest that individuals with PTSD and other psychopathology may have unique motivations for quitting smoking that could be usefully explored within smoking cessation treatment programs.

Evaluation of anxiety sensitivity among daily adult smokers using item response theory analysis

The present investigation applied Item Response Theory (IRT) methodology to the 16-item Anxiety Sensitivity Index (ASI) [Reiss, S., Peterson, R. A., Gursky, M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8] for a sample of 475 daily adult smokers (52% women; M(age)=26.9, S.D.=11.1, range=18-65). Using non-parametric item response analysis, all 16 ASI items were evaluated. Evaluation of the option characteristic curves for each item revealed 4 poorly discriminating ASI items (1: "It is important not to appear nervous;" 5: "It is important to me to stay in control of my emotions;" 7: "It embarrasses me when my stomach growls;" 9: "When I notice my heart beating rapidly, I worry that I might be having a heart attack"), which were dropped from analysis. Upon repeat analysis, the remaining items appeared to make adequate separations within levels of anxiety sensitivity in this sample. Graded response modeling data indicated important differences in ASI items' capacity to discriminate between, and provide information about, latent levels of anxiety sensitivity. Specifically, three items best discriminated and provided the most information regarding latent levels of AS-items 3, 15, and 16. Items 1, 5, 7, and 9 were omitted due to their limited capacity to discriminate between latent levels of anxiety sensitivity; items 8, 12, and 13 also performed poorly. Overall, current findings suggest that evaluation of anxiety sensitivity among adult smokers using the 16-item ASI may usefully choose to focus on items that performed well in these IRT analyses (items: 2, 3, 4, 6, 10, 11, 14, 15, and 16).

Relations between anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations to coping and conformity marijuana use motives among young adult marijuana users

The present investigation examines anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations in relation to Coping and Conformity marijuana use motives among a sample of young adult marijuana users (n = 135; 46.7% women; Mage = 20.45, SD = 5.0). After controlling for current marijuana use frequency (past 30 days), daily cigarette smoking rate, average volume of alcohol used over the past year, negative affectivity, and other marijuana use motives, anxiety sensitivity was significantly and uniquely associated with Coping and Conformity motives for marijuana use. Distress tolerance evidenced significant and unique incremental relations to Coping motives, whereas fear reactivity to bodily sensations was unrelated to any marijuana use motive. These results provide novel information related to the role of emotional sensitivity and tolerance factors as they pertain to specific types of motives for marijuana use among young adults.

An evaluation of anxiety sensitivity, emotional dysregulation, and negative affectivity among daily cigarette smokers: relation to smoking motives and barriers to quitting

The present investigation evaluated the relations between anxiety sensitivity and motivational bases of cigarette smoking, as well as barriers to quitting smoking, above and beyond concurrent substance use, negative affectivity, and emotional dysregulation among a community sample of 189 daily cigarette smokers (46% women; M(age)=24.97 years, SD=9.78). Results indicated that anxiety sensitivity was significantly related to coping, addictive, and habitual smoking motives, as well as greater perceived barriers to quitting. These effects were evident above and beyond the variance accounted for by concurrent tobacco, alcohol, and marijuana use and discernable from shared variance with negative affectivity and emotional dysregulation. Emotional dysregulation was significantly related to stimulation, habitual, and sensorimotor smoking motives and greater perceived barriers to quitting, whereas negative affectivity was only significantly related to smoking for relaxation. These findings uniquely add to a growing literature suggesting anxiety sensitivity is an important and unique cognitive factor for better understanding clinically-relevant psychological processes related to cigarette smoking.

Linkages between cigarette smoking outcome expectancies and negative emotional vulnerability

The present investigation examined whether smoking outcome expectancies, as measured by the Smoking Consequences Questionnaire (SCQ; [Brandon, T.H., & Baker, T.B., (1991). The Smoking Consequences Questionnaire: The subjective expected utility of smoking in college students. Psychological Assessment, 3, 484-491.]), were incrementally related to emotional vulnerability factors among an adult sample of 202 daily cigarette smokers (44.6% women; M(age)=23.78 years, SD=9.69 years). After controlling for cigarettes smoked/day, past 30-day marijuana use, current alcohol consumption, and coping style, negative reinforcement/negative affect reduction outcome expectancies were significantly associated with greater levels of negative affectivity, emotional dysregulation, and anxiety sensitivity. The observed effects for negative reinforcement/negative affect reduction also were independent of shared variance with other outcome expectancies. Negative personal consequences outcome expectancies were significantly and incrementally related to anxiety sensitivity, but not negative affectivity or emotional dysregulation. Findings are discussed in terms of the role of negative reinforcement/negative affect reduction smoking outcome expectancies and clinically-relevant negative emotional vulnerability for better understanding cigarette smoking-negative mood problems.

Evaluation of smoking characteristics among community-recruited daily smokers with and without posttraumatic stress disorder and panic psychopathology

The present investigation compared 123 community-recruited daily smokers with posttraumatic stress disorder (PTSD), panic disorder (PD), nonclinical panic attacks (PA), or no current Axis I psychopathology (controls; C) in terms of nicotine dependence, smoking rate, quit history, severity of symptoms during past quit attempts, and motivation for and expectancies about smoking. No differences were observed between groups in regard to smoking rate or nicotine dependence. The PTSD group reported making more lifetime quit attempts than the other groups, and the PTSD and PD groups perceived more severe symptoms during past quit attempts. The PD and PTSD groups reported greater motivation to smoke to reduce negative affect. Individuals with PTSD endorsed a stronger expectation that smoking would alleviate negative mood states and would produce negative consequences. Overall, results suggest that smokers with PD or PTSD differ from other smoking groups in a number of clinically significant ways.

Panic reactivity to voluntary hyperventilation challenge predicts distress tolerance to bodily sensations among daily cigarette smokers

The present investigation examined the extent to which panic reactivity to bodily sensations is related to distress tolerance (DT) among daily smokers. It was hypothesized that panic reactivity to an initial voluntary hyperventilation (i.e., whether participants met criteria for a DSM-IV panic attack; PA) would predict the relative degree of task persistence on a second hyperventilation trial (DT) above and beyond the variance accounted for by anxiety sensitivity (AS), negative affectivity (NA), cigarette smoking rate, and self-reported discomfort intolerance (DI). Participants were 95 daily smokers (58% women; M-sub(age) = 29.0, SD = 12.2) who completed a battery of questionnaires and two voluntary hyperventilation procedures. Results indicated PA status significantly predicted DT, above and beyond the theoretically relevant covariates of AS, NA, cigarettes per day, and DI ( p < .05). Such a result is consistent with theoretical models and empirical findings on emotional reactivity that suggest panic responsivity to internal cues may represent a key explanatory construct in terms of level of DT to interoceptive stimuli.

Panic attacks and physical health problems in a representative sample: singular and interactive associations with psychological problems, and interpersonal and physical disability

BACKGROUND

Panic attacks may be a risk marker for a variety of psychological problems and are associated with increased impairment in a host of domains. However, previous studies have not investigated the role of physical illness in the panic attack-disability relations, which is striking due to findings that physical illness is linked to both panic attacks and disability. The present investigation examined the singular and interactive effects of panic attacks and physical illness in relation to psychological, interpersonal, and physical types of impairment.

METHOD

Adult participants (4,745) recruited from the statewide Colorado Social Health Survey were administered the diagnostic interview schedule.

RESULTS

As predicted, main effects of panic attacks and physical illness were significantly related to psychiatric comorbidity, depressive symptoms, interpersonal functioning, physical functioning, and perceived general health (p<.05 for all associations). Also as predicted, interaction of panic attacks and physical illness was significantly related to all of the outcome variables (p<.05 for all associations).

CONCLUSIONS

These findings suggest that individuals with both panic attacks and physical illness experience elevated disability across a variety of dimensions.

Marijuana use motives: A confirmatory test and evaluation among young adult marijuana users

The present investigation evaluated the measurement model and construct validity of marijuana use motives as measured by the Marijuana Motives Measure (MMM; [Simons, J., Correia, C. J., Carey, K. B., and Borsari, B. E. (1998). Validating a five-factor marijuana motives measure: Relations with use, problems, and alcohol motives. Journal of Counseling Psychology, 45, 265-273]). Confirmatory factor analysis (CFA) and incremental tests of validity of marijuana use motives were conducted on a sample of young adult marijuana users (n=227, 127 women; M(age)=20.11, SD=4.30 years). As hypothesized, CFA analysis of marijuana use motives, as indexed by the MMM, demonstrated support for a multidimensional measurement model; specifically, a five-factor solution denoting Enhancement, Conformity, Expansion, Coping, and Social motives for marijuana use, each with satisfactory levels of internal consistency. Subsequent tests of incremental validity suggested that only certain motives were uniquely related to current substance use and cognitive-affective factors. Results are discussed in relation to refining the scientific understanding of marijuana use motives.

Incremental validity of anxiety sensitivity in terms of motivation to quit, reasons for quitting, and barriers to quitting among community-recruited daily smokers

The present investigation examined the relationships between anxiety sensitivity and motivation to quit smoking, barriers to smoking cessation, and reasons for quitting smoking among 329 adult daily smokers (160 females; M (age) = 26.08 years, SD = 10.92). As expected, after covarying for the theoretically relevant variables of negative affectivity, gender, Axis I psychopathology, nonclinical panic attack history, number of cigarettes smoked per day, and current levels of alcohol consumption, we found that anxiety sensitivity was significantly incrementally related to level of motivation to quit smoking as well as current barriers to quitting smoking. Partially consistent with the hypotheses, after accounting for the variance explained by other theoretically relevant variables, we found that anxiety sensitivity was significantly associated with self-control reasons for quitting smoking (intrinsic factors) as well as immediate reinforcement and social influence reasons for quitting (extrinsic factors). Results are discussed in relation to better understanding the role of anxiety sensitivity in psychological processes associated with smoking cessation.

Incremental validity of anxiety sensitivity in relation to marijuana withdrawal symptoms

The present investigation examined the relation between anxiety sensitivity (AS) and marijuana withdrawal severity among 84 (47 female) young adult marijuana smokers. As expected, after covarying for the theoretically-relevant variables of frequency of past 30-day marijuana use, number of cigarettes smoked per day, volume of alcohol consumed, and anxious arousal as well as anhedonic depressive symptoms, both the global AS factor and the AS-mental incapacitation concerns factor were significantly related to the severity of retrospectively reported marijuana withdrawal symptoms. Results are discussed in relation to better understanding cognitive-emotional variables related to the marijuana withdrawal.

Smoking motives in the prediction of affective vulnerability among young adult daily smokers

The primary aim of this study was to examine whether smoking to reduce negative affect was uniquely related to a range of affective vulnerability factors (e.g., anxiety sensitivity, anxious arousal, and negative affectivity) among daily smokers. Participants were 276 young adult daily smokers (124 females; M(age)=25.12, SD=10.37). Partially consistent with prediction, the motivation to smoke to reduce negative affect was significantly related to anxiety sensitivity and negative affectivity, but not anxious arousal; the observed significant effects were above and beyond other theoretically relevant factors (e.g., smoking rate, years smoked, age, gender). In contrast to prediction, habitual smoking motives demonstrated significant incremental associations with anxiety sensitivity and anxious arousal symptoms. These results suggest that there are important associations between certain smoking motives and negative affective states and that such relations are not attributable to other smoking factors (e.g., smoking rate).

Anxiety sensitivity and early relapse to smoking: A test among Mexican daily, low-level smokers

The aim of the present investigation was to extend previous work on anxiety sensitivity (AS) and early smoking relapse among a sample of 130 (74 females) young adult (M (age) = 22.5 years, SD = 2.1) daily low-level smokers (9.3 cigarettes/day, SD = 11.5) from Mexico City, Mexico. Results indicated that of the global-level and lower-order factors (i.e., physical, mental incapacitation, and social concerns) on the Anxiety Sensitivity Index, only the physical concerns factor was significantly related to early lifetime smoking relapse. This effect was observed above and beyond the effects of negative affectivity, cigarettes smoked per day, and alcohol consumption, as well as beyond the other AS mental and social concerns factors. Findings provide novel evidence that AS is an important explanatory construct in early smoking relapse.

Panic attacks, panic disorder, and agoraphobia: associations with substance use, abuse, and dependence

Anxiety and substance use disorders frequently co-occur. Despite the clinical importance of this co-occurrence, theory and research addressing the relations between anxiety-substance use disorder comorbidity remain limited. The present commentary is intended to briefly review and summarize key aspects of this literature, with a specific focus on panic-spectrum psychopathology (panic attacks, panic disorder, and agoraphobia) and its associations with tobacco, alcohol, and marijuana use, abuse, and dependence. A heuristic theoretical model for better understanding the panic-substance use relations also is offered. Extant data suggest clinically meaningful bidirectional associations are evident between panic problems and premorbid risk factors for such problems and various forms of tobacco, alcohol, and marijuana use. Key clinical implications and future directions are outlined based upon the review.

Approximate cross-validatory predictive checks in disease mapping models

When fitting complex hierarchical disease mapping models, it can be important to identify regions that diverge from the assumed model. Since full leave-one-out cross-validatory assessment is extremely time-consuming when using Markov chain Monte Carlo (MCMC) estimation methods, Stern and Cressie consider an importance sampling approximation. We show that this can be improved upon through replication of both random effects and data. Our approach is simple to apply, entirely generic, and may aid the criticism of any Bayesian hierarchical model.

A Bayesian hierarchical approach to comparative audit for carotid surgery

OBJECTIVES

the aim of this study was to illustrate how a Bayesian hierarchical modelling approach can aid the reliable comparison of outcome rates between surgeons.

DESIGN

retrospective analysis of prospective and retrospective data.

MATERIALS

binary outcome data (death/stroke within 30 days), together with information on 15 possible risk factors specific for CEA were available on 836 CEAs performed by four vascular surgeons from 1992-99. The median patient age was 68 (range 38-86) years and 60% were men.

METHODS

the model was developed using the WinBUGS software. After adjusting for patient-level risk factors, a cross-validatory approach was adopted to identify "divergent" performance. A ranking exercise was also carried out.

RESULTS

the overall observed 30-day stroke/death rate was 3.9% (33/836). The model found diabetes, stroke and heart disease to be significant risk factors. There was no significant difference between the predicted and observed outcome rates for any surgeon (Bayesian p -value>0.05). Each surgeon had a median rank of 3 with associated 95% CI 1.0-5.0, despite the variability of observed stroke/death rate from 2.9-4.4%. After risk adjustment, there was very little residual between-surgeon variability in outcome rate.

CONCLUSIONS

Bayesian hierarchical models can help to accurately quantify the uncertainty associated with surgeons' performance and rank.

Supply, distribution, and capacity of optometrists in Indiana

BACKGROUND

The Indiana Optometric Association and the Indiana Health Care Professional Development Commission identified a need to collect and analyze data on the health professions workforce for formulating goals and strategies to accommodate demands for health care services in Indiana. This study looks at the supply, distribution, and services of optometrists practicing in Indiana.

METHODS

Data compiled by the Indiana State Department of Health, Indiana Health Care Development Commission, and the Project HOPE Center for Health Affairs were analyzed with the results of a survey of practitioner members of the Indiana Optometric Association. Supply, distribution, services, provider-to-population ratios, per capita demand, and optometric productivity were used to evaluate the current and future capacity of Indiana optometrists to the year 2010.

RESULTS

An estimated 893 optometrists practiced in 86 of 92 counties and comprised 77% of the state's licensed eye and vision care workforce in 1995. Optometric workforce capacity appeared to be related to county population, but unrelated to the urban/rural classification or the per-capita income of Indiana counties. Contact lenses, disease, geriatrics, and pediatrics were the most prevalent areas of practice specialty.

CONCLUSIONS

Optometrist capacity in Indiana is sufficient at both the state and county levels, and optometric services are appropriately distributed such that patient access to optometric care is geographically unburdened. Estimates regarding supply are elastic, depending on the assumptions applied.

Reliability of league tables of in vitro fertilisation clinics: retrospective analysis of live birth rates

OBJECTIVE

To determine to what extent institutions carrying out in vitro fertilisation can reasonably be ranked according to their live birth rates.

DESIGN

Retrospective analysis of prospectively collected data on live birth rate after in vitro fertilisation.

SETTING

52 clinics in the United Kingdom carrying out in vitro fertilisation over the period April 1994 to March 1995.

MAIN OUTCOME MEASURE

Estimated adjusted live birth rate for each clinic; their rank and its associated uncertainty.

RESULTS

There were substantial and significant differences between the live birth rates of the clinics. There was great uncertainty, however, concerning the true ranks, particularly for the smaller clinics. Only one clinic could be confidently ranked in the bottom quarter according to this measure of performance. Many centres had substantial changes in rank between years, even though their live birth rate did not change significantly.

CONCLUSIONS

Even when there are substantial differences between institutions, ranks are extremely unreliable statistical summaries of performance and change in performance, particularly for smaller institutions. Any performance indicator should always be associated with a measure of sampling variability.

Hypertension and the eye: applications of the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure

BACKGROUND

High blood pressure is a major risk factor for coronary artery disease, kidney disease, and stroke. More people are aware of treating and controlling their blood pressure, but overall control rates are low and the incidence of hypertension-related morbidity and mortality remains high.

METHODS

The National Heart, Lung, and Blood Institute released The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) as the most recent national guideline to hypertension control for primary care clinicians.

RESULTS

JNC VI identifies 10 hypertension-related public health challenges: (1) prevent the rise of blood pressure; (2) decrease prevalence of hypertension; (3) increase awareness and detection of hypertension; (4) improve control of hypertension; (5) reduce cardiovascular risks; (6) increase recognition of importance of isolated systolic hypertension; (7) improve recognition of importance of high-normal blood pressure; (8) reduce ethnic, socioeconomic, and regional variations; (9) improve treatment; and (10) enhance community programs.

CONCLUSIONS

The eye is a target organ and retinopathy is a frequent complication--as well as a prognostic indicator--of sustained hypertension. As part of a multidisciplinary team approach, the optometrist assumes a significant role in the prevention, detection, evaluation, and treatment of high blood pressure and its associated morbidities.

Optometric manpower in the Commonwealth of Puerto Rico: estimates and projections, 1982-2025

BACKGROUND

The 1982 study investigated the potential impact of the IAUPR School of Optometry on the adequacy of supply of optometrists in Puerto Rico for the years of 1980-2000. This article is designed to: (1) update the 1982 study; (2) appraise the accuracy of the 1982 projections; (3) re-evaluate the status of optometric manpower in Puerto Rico through the year 2025; and (4) provide the School of Optometry with information necessary to make informed judgments about future enrollments.

METHODS

Estimates of supply are based on data from the Colegio de Optometras de Puerto Rico, the Sección de Oftalmología de la Asociación Médica de Puerto Rico, and the enrollment and graduation registries from the School of Optometry. Requirements are based on estimates of annual effective demand, provider-to-population ratios, per capita demand, and optometric productivity.

RESULTS

Optometrists comprised 52.2% of Puerto Rico's actively practicing vision care manpower in 1995, with a mean optometrist-to-population ratio of 8.2 per 100,000. The number ranged from 28 in Mayagüez to 107 in San Juan. Under different assumptions regarding supply, productivity, and demand, surpluses and deficits are estimated and projected for the years 1995 to 2025.

CONCLUSIONS

Depending on the assumptions used, an undersupply or an oversupply of optometrists may be found in Puerto Rico, currently and in the future. Projections of supply and demand predict a considerable range--from a surplus of 961 optometrists to a deficit of 2,085 optometrists in the year 2025.

Rationing the public's health and the optometric agenda

BACKGROUND

Universal access to health care at an affordable price is a major issue on the current agenda of the nation's legislative, corporate and health care decision makers.

METHODS

The current literature and prevailing ideologies on health service rationing and health care reform were reviewed and evaluated in the context of optometric practice.

RESULTS AND CONCLUSION

The socio-political nature of the decision making process may lead to recommendations for reforms and market interventions that contravene the agenda of health care providers. To maintain quality of care and contain costs, and as a basis for allocation, judgments must be made about the value of specific services. Some services may be rationed according to the ratio of benefit to cost and their perceived net value to society. If rationing prevails, optometric services will be included in the process of prioritization and allocation.

The optometric educators' role in public health issues

The optometric educator has a very important role in the development, analysis, interpretation, and promotion of public health issues. Because public health provides the framework for making rational decisions about the complexities of health care, the optometric educator has a high-order responsibility to educate students in the principles, concepts, and practice of public health. As both a creator and a deliverer of knowledge, the optometric educator also must ensure that the outcomes of his scientific inquiry are translated into relevant health policy and used effectively and efficiently for the benefit of all society. Advancement of the public health philosophy within the venue of optometric education should be the responsibility of all faculty, not just those members of the faculty who have direct responsibility for the public health curriculum.

Disposable vs. non-disposable contact lenses-the relative risk of ocular infection

The wearing of contact lenses is not without some risk. When prescribing contact lenses, several decisions must be made regarding the type of lens; for example, daily wear vs. extended wear and disposable or frequent replacement lenses vs. non-disposable or traditional (reusable) lenses. Often the decisions are based on issues of comfort, cost and/or the ability to fit the patient with one type or another. Consideration of a possible increase in the risk of ocular infection from contact lens wear is not necessarily a variable in the selection process, but maybe it should be. From the aspect of provider liability and as a public health issue, this paper will attempt to explore the relative risk of ocular infection associated with the wearing of disposable and traditional contact lenses.

Legislation, litigation, health policy and optometry

Significant changes in health policy have occurred during the past 25 years. Directed primarily by congressional legislation and judicial opinion, many of these changes have resulted from efforts to control costs, improve quality and increase access. Optometric parity, reimbursement reform, freedom of choice, mandated benefits, commercial speech, self-insurance, competition and peer review are some of the issues that surround many of the more recent attempts at change in the health care market. Optometry has been and will continue to be affected by changes in health policy, especially with regard to issues of cost, quality and access.

Assurance of quality vision care in alternative health care delivery systems

The continuing evolution of competitive arrangements in the marketing and delivery of health care services can have an adverse effect upon the quality of care. Traditional modes of health care delivery are being replaced by the more competitive alternative delivery and managed care systems. Practitioners, consumers, administrators and legislators are finding it increasingly difficult to balance the various issues that surround the desire for quality and the necessity of cost containment. Optometry must be able to establish its own standards and methods of evaluation for the assurance of quality eye care within the alternative delivery and managed care systems.

Racial differences in the presentation of chronic open-angle glaucoma

Glaucoma is the third leading cause of blindness in the United States. A review of the literature suggests that blacks biologically are at greater risk for higher intraocular pressure, open-angle glaucoma and glaucoma-induced blindness. Although the incidence of blindness from all causes is reported to be about three times higher for nonwhites in comparison to whites, the risk of blindness from glaucoma in blacks is eight times that of whites. As the most prevalent type of glaucoma in the general population, chronic open-angle glaucoma occurs in the black population more often, at an earlier age, with greater severity, and with more damaging results.

Dental management of a patient with glycogen storage disease type I

Patients with glycogen storage disease type I (GSD I) have varied medical problems, including a bleeding diathesis characterized by a prolonged bleeding time. A case of a patient with GSD I having a history of medical problems, some of which were related to oral and dental bleeding, was presented. The patient was cariesfree and had generalized moderate to severe periodontal breakdown. A treatment regimen in a hospital setting, using cryoprecipitate and aminocaproic acid, permitted dental care and control of oral bleeding and associated complications.

Report of the Graduate Medical Education National Advisory Committee to the secretary

The Graduate Medical Education National Advisory Committee (GMENAC) was charged with the task of advising the Secretary of the Department of Health and Human Services on overall strategies on the present and future supply and requirements of physicians by specialty and geographic location. In September of 1980, GMENAC submitted its final report to the Secretary. Included in this report are policy directives that were issued in the form of recommendations; several of these recommendations are directed specifically at the independent non-physician health care professions. The potential impact of these recommendations upon the profession of optometry is monumental; and, the authority of GMENAC to issue directives regarding the supply of optometrists and the future requirements of optometric manpower must be challenged.

The optometrist's role in public health

The scope of the optometric profession, and its relationship to the total health care system, is in a state of constant change; many of the changes are influenced by or impact upon that area of health care that is referred to as public health. Very basically, public health is "people's health" --a concern for the health and well-being of groups of people. It emphasizes the role of health care practitioners in the delivery of health care to the aggregate, as opposed to the individualized or private system of health care delivery. Fundamental to the overall philosophy of public health is the necessity to make comprehensive health care readily available and accessible to all segments of the population. Optometry must expand its efforts to recognize, evaluate and assume its role in the maintenance of the health and well-being of the public, both domestically and internationally.

An experiment in health careers recruitment: a summer program at Indiana University

During the summer of 1973, the Indiana University Division of Optometry, via a Special Project Grant from the National Institutes of Health, conducted its first Summer Institute in the Health Related Professions for High School and College Students. Twenty-seven high school students and twenty-nine college students were brought to Indiana University for intensive sessions in career awareness, curriculum and financial counseling, and academic coursework. Assisted by the staffs of Indiana Health Careers, Inc. and the Indiana University Coordinators for School Science, the Institute awakened new interests and goals, relative to the health career prospectus, within the trainees. As a direct consequence of the summer program, four participants in the college institute were matriculated into schools of medicine, pharmacy, and optometry during the semester following the culmination of the Institute; ten more are participating in the followup program for continued guidance and counseling, seeking 1974 entrance into health professions schools and colleges. This experiment in health professions recruitment for minority, disadvantaged, and low-income students proved to be a viable method of increasing the manpower pool of health professionals.