A mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients. Longitudinal monitoring is recommended to ensure that service provision is adequate across the pharmacy network.

Maternal influences on children's fear and coping behaviors during a medical examination were studied in a pediatric outpatient clinic using the Dyadic Prestressor Interaction Scale (DPIS) to measure anticipatory reactions just prior to contact with the physician. Analysis of 50 mother-child dyads, including children from 4 to 10 years of age, revealed that the behaviors emitted by mother and child are likely to influence the child's ability to tolerate the medical experience. Maternal use of distraction and low rates of ignoring were associated with lower child distress and increased prosocial behaviors. Children's active exploration of the situation was more likely to occur when mothers provided their children with information, and was less likely when mothers reassured their children. Maternal reassurance of children and overt maternal agitation were associated with more maladaptive child responses. Age trends were also found in interactive patterns. Younger children were more likely to receive reassurance from mothers when they showed attachment. There was a stronger association between mother's information giving and child's exploring for children under 5 years, 9 months of age. Results supported the usefulness of the DPIS for investigation of child management techniques in this situation. Theoretical extension to attachment and stranger-approach situations was made. Suggestions for future studies to clarify the reciprocity of interactions or to determine causal direction between mother and child behaviors, as well as to evaluate the specificity or generality of these findings, were provided.

This study tested a model of romantic jealousy based on cognitive motivational theory (White & Mullen, 1989) and formulations from adult attachment studies (Hazan & Shaver, 1987). A causal model was tested in which attachment, depression and situational threat were hypothesized to predict jealous responses through their effects on appraisal of threat. Imagery scenes, depicting varying levels of threat by a romantic relationship rival, were presented to 135 undergraduates. The model fit the data very well. Threat appraisal was predicted by attachment, depression and level of situational threat. Appraisal, in turn, predicted positive and negative relationship perceptions and emotions reported in response to jealousy-evoking situations. Results were interpreted as suggesting that attachment style and depression indirectly influence affective and cognitive responses to jealousy-evoking situations by functioning as schemas which influence the appraisal of a rival relationship. Insecure attachment and depression were also found to be related to less effective coping strategies. Findings regarding depression and ineffective coping suggested implications for the personal and relationship adjustment of persons with secure and insecure attachment.

No abstract

This study assessed the influence of a developmentally specific CD-ROM intervention on cognitive appraisals, fear, behavioral distress, and pain in pediatric hematologyoncology patients scheduled for intravenous (IV) procedures. Thirty children, 7 to 18 years of age, were randomly assigned either to a standard medical care group or a standard medical care plus CD-ROM intervention group. It was hypothesized that using the CD-ROM would decrease threat appraisals of the IV procedure, causing decreased fear of the IV, less behavioral distress, and less pain during the IV. It was also hypothesized that intervention-enhanced secondary appraisal would be seen in children in the CD-ROM intervention group and that they would cope more effectively with the IV procedure. Self-report and observational ratings were used to assess the following dependent variables: primary and secondary appraisal, fear, behavioral distress, and pain. Results indicated significant effects for the reduction of threat appraisals following CD-ROM intervention (p < .05). Children in the CD-ROM intervention group used cognitive restructuring coping more effectively than did the control group (p < .05). No significant effects were found for fear, behavioral distress, or pain.Children facing hospitalization and illness often undergo invasive and painful medical procedures. Cognitive-behavioral interventions have been found effective in helping these children cope with emotional and behavioral distress with a Correspondence should be sent to Joseph P. Bush, Fielding Graduate University, School of Psychology,

The experimental induction of jealousy threat in a specific situation, using an imagery task, affected subjects' perceptions of themselves and of their romantic relationships, and influenced their emotions. Jealousy-provoking situations increased subjects' perceptions of themselves as jealous in their relationships, and their perceptions of themselves as more emotionally involved in the relationship relative to their partners. Jealousy threat decreased levels of perceived security and stability of the relationship and self-perceived feelings of attractiveness and acceptability to partners. These jealousy-provoking scenes also elicited a complexity of emotions: decreased joy and an increased series of negative emotions. When subjects imagined themselves in a high threat condition, where the loss of their partners seemed imminent, they evaluated their relationships as significantly less secure/ stable, and reported greater intensities of surprise, fear and distress in contrast to the low threat scenes. Dispositional measures of self-esteem and jealousy did not significantly predict jealousy-induced relationship perceptions, although these person variables were somewhat correlated with subjects' ratings of characteristics of their relationships in general. It was concluded that situational variables, such as level of jealousy threat, affect both emotions and cognitions related to the self and relationship based upon the salient characteristics of the situation. Some evidence was found for an interactional explanation of romantic jealousy which requires further investigation.

This research suggests that clinical pharmacists in general practice in Dudley CCG are able to deliver clinical interventions efficiently and in high volume. In doing so, clinical pharmacists were able to generate considerable financial returns on investment. Further work is recommended to examine the effectiveness and cost-effectiveness of clinical pharmacists in general practice in improving outcomes for patients.

SummaryThis study aimed to assess the effectiveness of a novel, community‐based weight management programme delivered through general practitioner (GP) practices and community pharmacies in one city in the United Kingdom. This study used a non‐randomized, retrospective, observational comparison of clinical data collected by participating GP practices and community pharmacies. Subjects were 451 overweight or obese men and women resident in areas of high socioeconomic deprivation (82% from black and minority ethnic groups, 86% women, mean age: 41.1 years, mean body mass index [BMI]: 34.5 kg m−2). Weight, waist circumference and BMI at baseline, after 12 weeks and after 9 months were measured. Costs of delivery were also analysed. Sixty‐four per cent of participants lost weight after the first 12 weeks of the My Choice Weight Management Programme. There was considerable dropout. Mean percentage weight loss (last observation carried forward) was 1.9% at 12 weeks and 1.9% at final follow‐up (9 months). There was no significant difference in weight loss between participants attending GP practices and those attending pharmacies at both 12 weeks and at final follow‐up. Costs per participant were higher via community pharmacy which was attributable to better attendance at sessions among community pharmacy participants than among GP participants. The My Choice Weight Management Programme produced modest reductions in weight at 12 weeks and 9 months. Such programmes may not be sufficient to tackle the obesity epidemic.