Disasters are unpredictable and frequently lead to chaotic post-disaster situations, creating numerous methodologic challenges for the study of the mental health consequences of disasters. In this commentary, we expand on some of the issues addressed by Kessler and colleagues, largely focusing on the particular challenges of (a) defining, finding, and sampling populations of interest after disasters and (b) designing studies in ways that maximize the potential for valid inference. We discuss these challenges - drawing on specific examples - and suggest potential approaches to each that may be helpful as a guide for future work. We further suggest research directions that may be most helpful in moving the field forward.

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<p>Posttraumatic stress disorder (PTSD) is highly prevalent and has substantial economic and social consequences. In this article, we review the epidemiology of PTSD. We begin by summarizing the evidence about the prevalence and correlates of traumatic event exposure. Next, we discuss the prevalence of PTSD, the conditional probability of PTSD given specific traumatic event exposure, the correlates, and demographic distribution of PTSD, and the trajectory of PTSD over the life course. Lastly, we discuss the consequences of PTSD and the challenges facing this field of research today.</p> <H4>ABOUT THE AUTHORS</H4> <P>Jennifer Johnson, MPH, is with the Center for Global Health, University of Michigan, Ann Arbor. Andrea Maxwell, BS, is with the School of Medicine, University of Michigan. Sandro Galea, MD, DrPH, is with the Department of Epidemiology, School of Public Health, the Survey Research Center, Institute for Social Research, and the Center for Global Health, the University of Michigan. </P><P>Address correspondence to: Sandro Galea, MD, DrPH, Department of Epidemiology, 109 Observatory St., Room 3633, Ann Arbor, MI 48109-2029; fax 734.763.5706; or e-mail <A HREF="mailto:sgalea@umich.edu">sgalea@umich.edu</A>. </P><P>Ms. Johnson; Ms. Maxwell; and Dr. Galea have disclosed no relevant financial relationships. </P><P>doi: 10.3928/00485713-20090514-01</P> <H4>EDUCATIONAL OBJECTIVES</H4> <P><OL><LI>Identify the prevalence of traumatic exposure and posttraumatic stress disorder (PTSD) and their correlates in the general population and in special populations.</LI> </P><P><LI> Review research on the trajectory of PTSD.</LI> </P><P><LI>Discuss the challenges associated with PTSD research today.</LI></ol></p>

The best possible care of critically ill patients can be rendered when physicians of various specialties, nurses, and allied health professionals join forces and treat problems together." --Ake Grenvik

OBJECTIVES: To explore how care coordination changes conceptually and practically in primary care practices when implementing the medical home and to identify reasons for different types of changes.METHODS: Six years after a 2003-2004 national learning collaborative to implement the medical home model for children with special health care needs, we examined care coordination in 12 pediatric practices with the highest postintervention Medical Home Index scores, indicating high level of adoption of the model. Data included interviews of 48 clinicians, care coordinators, and parents and medical record reviews of 60 patients with special health care needs receiving care in these practices.RESULTS: Initially, care coordination activities were prompted by patients' acute problems, and over time activities, tools, and policies were implemented to avert many such problems and expand the scope of services offered to patients. Example activities were making previsit calls with families, writing care plans, developing relationships with community agencies, and tracking referrals. Although some activities were common across practices, the persons involved and efforts toward different activities varied with practice context. Drivers included motivation and creativity of medical home teams, organizational changes, funding to expand care coordinator positions, protected time for such activities, and adoption of electronic record systems. CONCLUSIONS:In high-performing medical homes, care coordination activities changed from being mostly reactive to patients' episodic needs to being more systematically proactive and comprehensive. This shift was promoted by factors external and internal to the practice. Ensuring these factors in medical home implementation may accelerate adoption of proactive care coordination activities. WHAT'S KNOWN ON THIS SUBJECT:Care coordination is a central part of the medical home model. Little is known about how care coordination is implemented in pediatrics and how it changes over time in primary care practices successfully adopting medical home principles. WHAT THIS STUDY ADDS:In high-performing medical homes, care coordination evolved toward designing and carrying out routine activities and policies that aimed to forestall disruptions in care delivery. Investing in medical home teams, engaging electronic medical record systems, and improving workflow supported these changes.