Illness and Satisfaction With Medical Care

Patients who have worse physical or mental health are less satisfied with their medical care than patients in better health. This article describes research that explores the causal underpinnings of this correlation. Does poor health cause dissatisfaction, or does dissatisfaction cause poor health? And is the dissatisfaction of sicker patients attributable to their own state of mind, or rather to how they are treated by their doctors? It appears that, predominantly, dissatisfaction follows from poorer health rather than vice versa, and moreover that sicker patients' negative outlook is a pervasive cause of their lower satisfaction. However, there is also evidence that physicians' reactions to sicker patients, in the form of curtailed social conversation, also play a role in the reduced satisfaction of these patients.     

疾病的意义与意义关怀

意义是人类关怀传达的基本要素和内容.意义关怀是医务人员在对患者及其家属现时疾病意义理解、认知的基础上,通过互动交流,形成共享意义的过程.理解意义是意义关怀的起点,疾病的意义包括现实意义和符号意义.意义关怀过程包括构建伙伴关系、有效的互动交流、形成共享意义三个阶段.     

Women,Mental Health,and Managed Care

Abstract

Managed care has changed the way that mental health care is provided. These insurers manage such factors as length and type of therapy made available, access to therapy, and level of payment for therapy. Women, as the majority of those insured by managed care and as consumers of mental healthcare, are differentially affected by these changes.     

Health and Illness from an Islamic Perspective

The Islamic understanding of the human self, its purpose and functions has a great effect on Muslims' understanding of themselves and on Islamic culture. Islamic psychology is a field that examines the Islamic perspective on health and illness and compares it to the Western perspective. The purpose of this paper is to introduce readers to the Islamic understanding of the self, its functions, and purpose, and to contrast it with Western theories about the self. It also aims at understanding Islamic definitions of health and illness and Islamic understanding of treatment.     

Health Care,Capabilities, and AI Assistive Technologies

Scenarios involving the introduction of artificially intelligent (AI) assistive technologies in health care practices raise several ethical issues. In this paper, I discuss four objections to introducing AI assistive technologies in health care practices as replacements of human care. I analyse them as demands for felt care, good care, private care, and real care. I argue that although these objections cannot stand as good reasons for a general and a priori rejection of AI assistive technologies as such or as replacements of human care, they demand us to clarify what is at stake, to develop more comprehensive criteria for good care, and to rethink existing practices of care. In response to these challenges, I propose a (modified) capabilities approach to care and emphasize the inherent social dimension of care. I also discuss the demand for real care by introducing the ‘Care Experience Machine’ thought experiment. I conclude that if we set the standards of care too high when evaluating the introduction of AI assistive technologies in health care, we have to reject many of our existing, low-tech health care practices.     

市场、价值取向、政府之于医疗卫生

分析了现代医疗卫生服务的消费品属性并将其划分为3大部分,由此形成的不同供给渠道,决定了医疗卫生服务的市场运作方式的必然性,但必须坚持始终如一的正确的价值取向——社会公众利益最大化的医疗卫生服务的基本目标。强势的政府主导是医疗卫生改革与发展的关键,提出了当前政府主导作用的具体意见和建议。     

市场、价值取向、政府之于医疗卫生

分析了现代医疗卫生服务的消费品属性并将其划分为3大部分,由此形成的不同供给渠道,决定了医疗卫生服务的市场运作方式的必然性,但必须坚持始终如一的正确的价值取向--社会公众利益最大化的医疗卫生服务的基本目标.强势的政府主导是医疗卫生改革与发展的关键,提出了当前政府主导作用的具体意见和建议.     

Rights, Duties and Responsibilities in Health Care

ABSTRACT The value of autonomy is generally stated to be of prime importance in relation to health care. Arising out of this, rights of the patient to and in health care have been extensively discussed and stated, and have found expression in law. There have been minimal statements of the rights of others involved in health care, such as caregivers, and minimal discussion of duties and responsibilities in relation to rights claimed and conferred. The author suggests that no claim to rights in health care should now be accepted without consideration of related duties and responsibilities.     

Bilingualism in the World of Health and Illness

The movement of peoples across linguistic boundaries means the existence of individuals who speak, to a greater or lesser extent, more than one language. How such individuals have in the past and can in the present serve as mediators within the health care system is described and the need for closer attention to such resources stressed.     

Attitudes of Health Care Trainees About Genetics and Disability: Issues of Access, Health Care Communication, and Decision Making

Prior studies suggest that knowledge and attitudes of health care professionals influence patient communication and medical decision making. To study this dynamic in the context of genetic disability, we developed a survey on health professionals' attitudes regarding disability and genetic screening and pilot-tested it on a sample of medical students, residents, and genetic counseling students (N = 85). Despite minimal experience with disability or genetics, most respondents reported feeling comfortable dealing with genetics (59%) and disability (75%). The majority felt that disability caused significant suffering for both the person (51%) and family (64%), and that research should be directed toward preventing genetic disability (62%). Similar to prior literature, perceived Quality of Life was most often based on degrees of physical and cognitive functioning, pain, and social support. However, differences were found between genetic counseling trainees and other medical trainees in their relative emphasis of social versus medical issues in questions of disability and genetic testing, and these response patterns were associated with differences in the groups' priorities for offering information about social resources. Respondents agreed that access to genetic testing and information is personal and that testing should be available upon request for oneself (68%) and to a lesser degree for one's fetus (55%) or child (41%). However, the same individuals frequently stated that society should regulate access to such technologies. Although most felt that the patient and professional should jointly make such decisions on a case-by-case basis, it was also seen as appropriate for the health care professional to occasionally decline genetic testing. It seems apparent that training and experience influence knowledge and attitudes. Therefore, it is critical to document knowledge and attitudes of various health care providers and trainees, including differences between various specialties, to improve educational interventions geared to this area.     

Illness Perceptions and Health: Innovations and Clinical Applications

Using a self-regulatory process, individuals act upon their cognitive and emotional representations of health threats to actively manage their health. Leventhal’s common-sense model describes cognitive representations of illness that include perceptions about the identity, timeline, consequences, control and cause of illness. Research has shown that individuals’ illness perceptions predict health behaviours and functional outcomes, particularly when perceptions are specific. Psychometric assessments of illness perceptions need to have the ability to detect specific and idiosyncratic perceptions and emotions; methods include rating scales and patients’ drawings of their illness. Recent randomised trials have demonstrated that interventions can change illness perceptions and improve health outcomes in patient groups, including those with normal test-results, and that family members also benefit from such interventions. These innovations inform clinical applications for improving patient health.     

Rock: An Unlikely Metaphor for Spirituality,Family Therapy,Mental Health and Illness

This article brings together fragments of a conceptual scheme and a number of big ideas: religious faith, contexts of African American spirituality, mental health and illness; and family therapy and the extended metaphor of sedimentary rock formation. Religion and spirituality are used somewhat interchangeably in this essay to signify embodied spirituality and sacred unity. The rock metaphor captures the idea of multiple entities that, like layers of sedimentary rock, make up families and communities and provide cohesion and a connection with the past. The rock metaphor captures the quality of hardness that may have either a positive of negative meaning and that allows for resilience in the face of adversity. Both qualities can be found in African American spirituality and Black churches. Both qualities have a relationship with the numinous. The qualities of the rock and their relationship with the numinous offer family therapists’ new insights and ways to think about how to approach a clinical presentation.     

Fetal Programming: Prenatal Origins of Health and Illness

ABSTRACT— Research on young animals and humans has demonstrated the critical importance of the fetal stage as a formative period in normal development. However, the significance of these findings has not always been incorporated into our thinking when trying to elucidate the origins of health and disease. It is not only that babies react to the state of the mother and to salient environmental events while still in the uterus. This stimulation and priming seems to be essential for guiding the optimal maturation of the nervous, endocrine, and immune systems. Experiences during prenatal life also program the regulatory set points that will govern physiology in adulthood. During this malleable maturational phase, these biological processes should be viewed as flexible "learning systems" that guide the developmental trajectory toward health or derail it toward pathology. Our studies on infant primates have shown that the competence of their immune responses and the structure and activity of certain brain regions, as well as many aspects of behavior and emotional reactivity, are strongly affected by the pregnancy conditions of their mothers.     

Multiple Sclerosis and Economic Well-Being: Role of Health, Age, and Duration of Illness

This study used quantitative and qualitative techniques to examine the role of health, age, and duration of illness among people with multiple sclerosis (MS) in their economic well-being. Participants were 113 adults (31 males and 82 females) with MS who lived in urban and rural regions of Australia. The results demonstrated that health and age had a significant impact on both the economic well-being and psychological adjustment of people who contract this disorder. Different health variables predicted different aspects of economic well-being. Fatigue was the major health variable that predicted costs of MS and economic pressure, with age also predicting economic pressure, whereas income levels were predicted by cognitive confusion and mobility problems. Duration of illness, gender, and urban/rural location were not significant predictors of the economic variables. These results demonstrate the importance of obtaining multiple measures of economic well-being, as well as a broad range of health-related measures, in determining the impact of MS on the economic well-being of people with this disorder.     

社会资本与卫生保健

社会资本概念于 2 0世纪 70年代后期由经济学家洛瑞在资本概念内涵扩展的基础上首次提出。 2 0世纪 90年代以来 ,社会资本逐渐成为人们关注的热门概念和分析的起点[1] ,对经济增长和社会发展起到了重要的推动作用并提供了科学的理论解释范式。近年来 ,世界银行对社会资本给予了充分的重视并鼓励各个领域引入社会资本理论进行研究。因此 ,阐明与卫生保健相关的社会资本要素 ,探讨社会资本的卫生保健功效对卫生保健工作具有重要的指导意义。1　社会资本理论的界定不同学者针对各自的研究领域和研究对象提出了不同的社会资本概念。国外学者中 ,…     

Mental Health and Managed Care

In this essay I continue the conversation going on today on the crisis in delivering mental-health care within the realities of managed care. A guiding perspective is represented briefly in material from the writings of Edmund Pellegrino. He recommends the norm of patient-centered relationships to direct and govern managed care so cost can be controlled, but not by the sacrifice of quality of care. This emphasis must be balanced with a struggle for the greater social good and fair allocation of goods to all citizens. Definitions are offered along with a discussion of controversial issues and constructive suggestions to make possible a better future for the work of mental health in relation to managed care.