Complexity of health care needs and interactions in multidisciplinary medical teams

By using an information processing and social identity approach, this study examines the relationships between the complexity of the health care needs of a patient and (1) the interactions among physicians during team meetings and (2) how the meeting participants evaluate the discussion. Three dimensions of the complexity of the health care needs are related to the interactive behaviour of medical specialists during meetings of multidisciplinary medical teams. Three medical teams from a Dutch university hospital, each discussing a total of 40 patients, were observed. The results show that component complexity was positively related to the amount of information team members exchanged, to positive reactions, and to the positive evaluation of the discussion. Two other dimensions (interrelatedness of needs and ambiguity) have to be considered in concert: interrelatedness was positively related to negative reactions but only if ambiguity was low; and, further, ambiguity was positively related to evaluative behaviour and to positive reactions, and negatively to the evaluation of the discussion, but only if interrelatedness was low.     

公共卫生人才调查及培养的思考

对江苏省部分市、区、县级疾病预防控制中心和卫生监督所的公共卫生队伍现状、人才需求进行了调查分析,为我国公共卫生教育提供了科学的依据。认为江苏省公共卫生系统现有人员素质有待进一步提高,医学高等院校应该加强公共卫生人才的培养。     

Training needs among nonmental health professionals working with service members: A qualitative investigation

Though many service members will not directly seek mental health care due to stigma and other factors, they may interact with the healthcare system in other ways including contact with first responders, nurses, and allied health care professionals. However, little attention has been spent in this regard on the educational needs of these professionals whose contact with service members and Veterans may provide the opportunity to assist Veterans in need with overcoming barriers to accessing mental health care. This qualitative study investigates the educational training needs of first responders and health care professionals in contact with military families and trauma survivors to determine whether, and what type, of additional training is needed. A sample of 42 first responders and health care professionals including emergency medical technicians, police officers, fire fighters, speech language pathologists, occupational therapists, physical therapists, and nurses were recruited to participate in 1 of 6 focus groups. Sessions were audiotaped and transcribed verbatim. Data analysis was guided by a thematic analysis approach. Thematic analyses suggest there is a significant knowledge gap with unmet educational needs of these professionals such as information on the invisible wounds of war, military culture, and screening and referring patients who present symptoms falling outside professionals’ scope of practice. Findings point to a need and desire for more robust education for first responders and health care providers around mental health concerns of military populations, including topics such as trauma, military culture, and screening tools. Efforts to develop curricula addressing these concerns are warranted.     

Ethical considerations of the short-term and long-term health impacts, costs, and educational value of sustainable development projects

There are over 800 seventh to tenth grade students at the College d’Enseignment Generale (CEG) School in Azové, Benin. Like most children in the developing world, these students lack access to clean water and basic sanitation facilities. These students suffer from parasitic infection and health ailments which could be directly offset with short term aid to supply water and medical aid. Promoting proper sanitation and providing the technology to implement water and wastewater treatment in the community will decrease childhood and maternal disease and mortality rates in Azové. However, these measures may take several years to implement and will require a significant investment in the infrastructure of the school. Is it ethical to spend $10,000 towards the long-term goals of providing water and sanitation to the students of CEG Azové, compared to spending the same amount on short-term relief efforts? This paper addresses the ethical dilemma of dealing with immediate medical needs in developing countries while trying to implement sustainable technologies. The views and frustration of students working on the project are discussed, as they realize the monetary and short-term impacts on human health when implementing sustainable technologies. The opportunity costs associated with the education principles of sustainable development were also considered. The anticipated costs and health impacts in the short-term and long-term will be evaluated for a period of 1, 2, 5 and 10 years.     

Adolescent health needs. II: Utilization of health care by adolescents

In a random, mailed survey, 730 adolescents supplied information on their patterns and preferences for health care. The majority of respondents reported that they usually receive medical care from a private physician. Girls consulted physicians more frequently than boys, but there was no significant variation by age or social group. As the age of the respondent increased, the proportion visiting pediatricians decreased. When asked what they liked and disliked about their physician, respondents placed great emphasis upon the personal characteristics of the practitioner. Long waiting periods were the most common complaint. A significant proportion of adolescents with health concerns do not consult a health professional, even in cases where efficacious treatment may be available. Nervous/emotional problems, obesity, and birth control are concerns of adolescents which should be discussed with health professionals.     

The VA Maryland Health Care System's telemental health program

The VA Maryland Health Care System introduced videoconferencing technology to provide psychiatry, evidenced-based psychotherapy, case management, and patient education at rural clinics where it was difficult to recruit providers. Telemental health services enable rural clinics to offer additional services, such as case management and patient education. Services have been expanded to urban outpatient clinics where a limited number of mental health clinic hours are available. This technology expands the availability of mental health providers and services, allowing patients to receive services from providers located at distant medical centers.     

Prevention and public health. Psychology's response to the nation's health care crisis

Psychology as a scientific and applied discipline has a unique responsibility to participate in the pursuit of strategies that reduce the nation's health care needs. As a social and behavioral science, psychology can contribute to unraveling the processes underlying conditions of health and disorder. As an applied discipline, psychology can work to design effective interventions to promote human health and to avoid disease and dysfunction. Insofar as these endeavors are unsuccessful, psychology can help reduce significant contributors to the nation's morbidity and mortality. Achieving such success, however, challenges psychologists to collaborate effectively, to combine science with practice and policy, and to address complex philosophical and ethical issues concerned with individual freedom and public responsibility.     

Introduction to the special section on health and cognitive function.

Numerous factors related to health and diseases have been studied in relation to cognitive function. It has been shown that across the life span, systemic medical diseases can negatively impact cognitive function. Factors that influence the development of medical diseases, such as poor health habits, biological risk factors, hormones, genetic factors, exposure to environmental toxins, and certain treatments for disease, can also have an adverse effect on cognitive function. Conversely, factors such as high levels of education, good health habits, and some treatments for disease can be protective. Included in this special section are 6 empirical articles that examine the relation of health or disease to cognitive function.     

National agenda for children with special health needs. Social policy for the 1990s through the 21st century.

The evolution in medical technology for children with special health care needs has been accompanied by an evolution in concepts of care. Broadened diagnostic categories, comprehensive concern for the whole child, and coordinated services that are family-centered and community-based have become part of the national agenda. During the 1980s this agenda was advanced both by congressional action and by joint activities of the U.S. Public Health Service and the private sector. Much remains to be accomplished. Increased parent participation and activism, an integral part of the future, will require vigilant nurturing and support.     

Games for health conference 2004: issues, trends, and needs unique to games for health.

The first-ever Games for Health Conference (Madison, WI, September 16-17, 2004) identified issues, trends, and needs unique to games for healthcare. More than 130 doctors, educators, therapists, and game makers gathered to share experiences particular to the health industry, health practitioners, and patient treatment. Co-sponsored by Games for Health, Project of the Serious Games Initiative, the Academic ADL Co-Lab, and the Federation of American Scientists, the conference highlighted applications for direct patient care and therapy, as well as health education, policy, and management ideas. This paper presents key concepts from the conference's panel discussions and summarizes successful projects demonstrated at the conference that can serve as models for the field.     

An evaluation of the UK government health education campaign on AIDS

In the absence of an effective treatment for HI V the only means of containing its spread is through changes in behaviour. Health education is a key route for achieving this. To be effective, a health education campaign must result in behaviour change. The United Kingdom Department of Health and Social Security has attempted to address these needs in a recent health education campaign, which took the form of whole page newspaper advertisements in the national press. Groups of higher and lower risk subjects were questioned before and after the campaign. The desire for information was high and the vast majority of respondents named the medical profession as the desired source to turn to. 31.1% of the lower risk group and 50% of the higher risk group noticed and read the campaign. Information scores were slightly increased but the campaign had no effect on adjusting misconceptions and anxiety was not lowered. Attitudes and behaviour were unaltered. These results are discussed in the light of a content analysis of the campaign.     

Mental health needs of the chronically mentally ill elderly

The treatment histories and current social, financial, and clinical status of 111 chronically mentally ill (CMI) persons over the age of 60 were examined. Information was obtained from Ss, family, mental health records, and mental health professionals familiar with Ss. Psychiatric symptoms were observed in 74% of Ss. Many Ss experienced long periods without acute episodes of illness. Recurring episodes eventually appeared in most Ss, however, and ongoing deficits in daily functioning and social contacts were prototypical. Two thirds of the Ss were living in the community, relying heavily on family contacts; the rest lived primarily in nursing homes (23.4%) or psychiatric hospitals (7.2%). Social support was the best predictor of level of functioning. Findings suggest that failure of CMI elderly to use mental health services is not due to lack of need. Mental health services currently do not appear to be meeting the needs of this population.     

An assessment of the needs of mutual-help groups

Assessed the needs of mutual-help groups in relation to how self-help clearinghouses can best assist. Most important problems centered on member involvement, attendance and recruitment, lack of public awareness, and finances. Most important needs were for greater public education and more referrals to groups. Significant differences were found across different types of organizational affiliation for the problems of recruitment of members, lack of public awareness, and problem members. The dynamic nature of mutual-help groups may naturally produce many of the turnover, attendance, and involvement problems which in turn generates the ongoing need to recruit new members in part through greater public awareness. Many of the goals and needs of mutual-help groups, coupled with the large number of group members, may lead to significant social and policy change in health and mental health services.     

Adolescent health care in Brazil

The period of youth and adolescence has been shown to have continuous demographic growth in the developing world. Young nations thus have to contend with the specific health needs of teenagers and young adults. This is illustrated by an analysis of the health-care needs of Brazilian adolescents. The issues highlighted here are adolescent morbidity and mortality, current delivery of adolescent health care, and future directions of adolescent programs in Brazil.     

Comparing the mental health needs of female and male incarcerated juvenile delinquents

The present study was undertaken to survey the prevalence of mental disorder in juvenile justice facilities and to compare the mental health needs for females and males. Girls displayed significantly more mental health needs than boys. The estimated prevalence of mental disorder for boys was 27%, compared with 84% for girls. The difference is highly significant and is discussed in terms of service system issues in juvenile justice that affect males and females differently. ©1997 John Wiley & Sons, Ltd.     

Positive emotion and health: going beyond the negative.

This study examined the relationships between positive emotions and health. Two positive emotions were considered, hope and curiosity, in conjunction with 3 physician-diagnosed disease outcomes: hypertension, diabetes mellitus, and respiratory tract infections. Medical data were abstracted over a 2-year period from 1,041 patient records from a multispecialty medical practice, and emotions were assessed through a mailed questionnaire. Across 3 disease outcomes, higher levels of hope were associated with a decreased likelihood of having or developing a disease. Higher levels of curiosity were also associated with decreased likelihood of hypertension and diabetes mellitus. Results suggest that positive emotion may play a protective role in the development of disease.     

Perceived health following myocardial infarction: cross-validation of the Health Complaints Scale in Danish patients

With an ageing population and a decline in cardiac mortality rates, the number of patients with cardiac disease is increasing, which in turn poses a major challenge for secondary prevention. For this end, appropriate, sensitive, and validated instruments to assess health complaints and quality of life are required. The objectives of the current study were: (1) to cross-validate the Health Complaints Scale (HCS) in a Danish sample of patients with a first myocardial infarction (MI); and (2) to investigate whether perceived health, as measured by the HCS is related to cardiac disease severity. The HCS was originally developed in Belgian patients with coronary artery disease. One-hundred-and-twelve consecutive patients with a first myocardial infarction were assessed by means of a questionnaire four to six weeks post infarction. Clinical measures were sampled from medical records. The factor structure of the HCS and the internal consistency of the Somatic Complaints (alpha = 0.91) and Cognitive Complaints subscales (alpha = 0.94) were confirmed. The construct validity of the scale was confirmed against measures of psychopathology and personality. Patients scored significantly higher on the HCS Somatic and Cognitive scales as compared with self-reports of depression and anxiety (p < 0.0001). Health complaints were unrelated to severity of cardiac disease and rather reflected subjective perception of quality of life. These findings show that the HCS is a valid instrument that is equally applicable in Danish cardiac patients to monitor perceived health as a major component of quality of life.     

Cuban health psychology: A priority is the primary health care system

Cuban health psychology has experienced a great expansion during the last 25 years, both in the number of psychologists and in range of activities in the field. Today, psychologists are integrated at all levels of the national health system, an achievement which is particularly interesting in that Cuba is a developing country. In a position isolated from trends in international psychology, Cuba has developed a role for psychologists within the field of health which is adapted to its situation as a poor and socialistic country. Priority is given to preventive and community-based psychology within primary health care facilities. Psychologists in primary health care serve a composite client-group, with high priority given to pregnant women and to children. The work of these psychologists covers a wide range of health problems—-physical as well as mental—and focuses upon individuals as bio-psycho-social units. Their responsibilities include health promotion, disease prevention, consultation and treatment, rehabilitation, research and education. This report is based on a 2½ month long field study in Cuba, where Cuban health psychology, particularly as it relates to primary health care, was explored.     

The mental health system and older adults in the 1990s.

Trends in mental health services for older adults during the past decade were used to predict salient issues for the current decade. These include overreliance on inpatient treatment, increased use of general hospitals as treatment sites, inadequate integration with the nursing-home industry, and insufficient mental health referrals from general medical providers. In the decade ahead, the mental health needs of older adults are unlikely to be an identified focus; rather the issues will overlap with other priorities (e.g., biomedical research on brain functioning, alternative treatment programs for the chronically mentally ill, and containing health care costs). Advocates for the elderly will be successful to the extent that they cast aging services within the context of these other concerns.