Implementation of an Adapted Collaborative Care Model.

Kosrae is an island state in the Federated States of Micronesia, a low- to middle-income country. Kosrae Community Health Center, an independent nonprofit organization, partnered with the Department of Psychiatry at the University of Hawai'i to integrate behavioral health services by using the collaborative care model (CoCM). The partnership encountered logistic and cultural challenges, but regular communication, case reviews, and training sessions enabled successful CoCM implementation. This success indicates that CoCM can be adapted in a remote island nation with finite resources. Findings indicate that planning for a longer implementation period may be required for international collaborations with limited previous experience in behavioral health.

Trauma in the Russian Federation: then and now.

BACKGROUND: Russia has made substantial, largely unrecognized contributions to the field of trauma. These include the early development of triage, improvement of blood transfusions and blood bank networks, and Mobile Emergency Medical Services. Despite these advances, injury fatality rates in Russia are alarmingly high (∼50% higher than other Eastern European countries). They fluctuated dramatically during 1980 to 2006, a period that included the dissolution of Union of Soviet Socialist Republics. Suggested causes, including inaccurate data, alcohol use, and economic hardship, are investigated in this article. METHODS: Injury mortality rates for homicide, suicide, accidental poisoning, and total injuries (source: World Health Organization), alcohol consumption (source: World Health Organization), and economic data (source: United Nations Economic Commission for Europe) for the Russian Federation from 1980 to 2006 were examined and compared with the Baltic States, Central Asian Republics, other Eastern European nations, and the United States. RESULTS: Injury mortality rates declined in Russia from 1980 to 1987. The total injury mortality rate more than doubled between 1987 and 1994, followed by a 40% decline from 1994 to 1998. The 1984 to 1994 mortality rates generally parallel alcohol consumption trends. The 1991 to 1994 climb coincides with the dissolution of the Union of Soviet Socialist Republics. A smaller rise in fatality rates occurred in the early 2000s. CONCLUSIONS: Deaths caused by injuries in the Russian Federation are related to multiple factors. Some authors conclude that the data accurately reflect injury mortality. Financial concerns during these times may have led to riskier behaviors resulting in more deaths from injuries. Heavy alcohol consumption also likely contributes to high injury mortality rates. Excessive injury mortality calls for action by Russian policy makers.