Identifying Differences of Environmental Ethics and Place Attachment Among Visitors and Managers at State Parks

ABSTRACT

Understanding place attachment and environmental ethic variables may improve management of natural areas, including enhanced communication related to management practices, managing various natural resources for specific or designated uses, and mediating significant differences between visitors and managers. Bridging any gaps of knowledge and understanding between visitors and those taking care of these natural places may enhance use and management of those areas into the future. This study elicited place attachment, environmental ethics, and demographic information from visitors to four state parks in Oklahoma. State park managers and state park visitors were found to be significantly different in their levels of place attachment and environmental ethics. Using t tests and discriminant analysis, researchers were able to use proenvironmental ethics and place identity to explain and predict the significant differences between the two groups. Implications for natural resource management include improved resource conservation and sustainability through enhanced education, interpretation efforts, and specific programming to connect people to natural places.     

The Health and Social Service Needs of Transgender People in Philadelphia

SUMMARY

Two Philadelphia-based HIV service organizations and a local university collaborated on a study of health and social service needs of transgender people. Transgender people were the primary resource for the development of the needs assessment survey. In this article, the survey development process, including two discussion groups and two focus groups, are described. Findings on barriers to care, violence, perception of public safety and comfort, suicide and health and social service needs are presented. Total sample size was 81, with 49 male-to-female and 32 female-to-male transgender individuals. Most (68%) were African American. About half of the respondents had thought about attempting suicide. High levels of violence were reported, especially among male-to-females. Health and social service needs included job training/work, dental care, health care, legal services, transportation, education and housing.     

Les psychologues dans le champ de la santé mentale : les perspectives en promotion de la santé mentale positive

Literature findingsMental health promotion is still insufficiently known by psychologists and few of them work in this field, in part because it is based on public health concepts and data. Furthermore, its approach is focused on positive health – as opposed to deficit models – which proposes interventions consisting in developing human competencies and strengths as a means of preventing potential future mental illnesses.DiscussionThe present stake, in the field of mental health, thus requires a paradigmatic change in psychologists which would enable to move from mainly curative interventions to actions oriented towards individual and collectives’ potentialities. This article presents a synthesis of mental health determinants as well as national and international public policies aiming at developing health promotion.ConclusionIt concludes on how psychologist could become major actors in this field.     

Interactions entre règles sociales de santé publique : étude des liens entre le port du masque et les règles routières en temps de crise sanitaire

IntroductionThe health crisis that France has experienced since the beginning of 2020 has justified the introduction of new health rules requiring changes in behaviour. The context of the implementation of these health rules, instituted very recently and for a limited period of time, raises the question of their perception and respect among the population.ObjectiveMobilising the social developmental psychology, the objective of this article is to explore inter-individual differences in the perception of these health rules measured through the wearing of masks. It aims also at studying the links between these perceptions with the experience of the health context and the perception of other legal public health rules, apprehended through some road safety rules.MethodThe questionnaire survey, carried out during the second confinement with a representative sample of 4999 people, made it possible to measure the experience of the health context, the internalisation of the rules and their justifications, the usefulness of the rules and the perception of the legal system.ResultsThe results show the links between internalisation, the type of arguments used to justify it for wearing a mask and for road rules respectively, as well as the links between internalisation and the perception of the legal system. They also show that women use moral and prudential arguments more to justify their internalisation of rules and that they have internalised the traffic rules (but not the wearing of masks) more than men.ConclusionThese results show that the perception of the rule of wearing a mask is more related to the general perception that individuals have of the legal system and other legal public health rules involving the relationship with others than to the context in which these rules were put in place.     

Duties When an Anonymous Student Health Survey Finds a Hot Spot of Suicidality

Abstract

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that included school-level analysis discovered a school with alarmingly prevalent student suicidality. Given confidentiality protocols typical of surveillance, the surveyors were uncertain whether and how to intervene. We searched literature for duties to warn at-risk groups discovered during public health surveillance, but we found no directly applicable guidance or cases. Reasoning by analogy, we conclude that surveyors should contact the school’s leaders to call attention to its outlier status, but public warning is unwarranted. However, such an ad hoc decision to issue a warning, even if only to school leaders, raises significant practical, legal and ethical issues. National public health and education associations should produce guidance that clarifies ethical and legal duties owed to schools and students involved in population health-risk surveillance.     

The Primary Prevention of Illness: Social Systems and Personal Power

There is evidence to be inferred from statistics about health status and mortality rates that a large proportion of illness and premature death is preventable. Primary prevention programmes appear to have had only limited success when individuals need to take responsibility for preserving their own health. This paper examines the concept of primary prevention and its assumptions, including the need to increase the sense of personal power of individuals. It also deals with some of the problems for primary prevention policies and their implementation. Other primary prevention issues such as ethical and legal considerations. cost-benefits, foci of programmes, and the specification of goals and objectives, are considered. We propose public (government) policies to broaden the concept of health sciences for research and practice, and to give a high priority for resource allocation to prevention of illness and promotion of health, including funding of interdisciplinary research teams. We advocate taking a general systems theory approach to prevention, while enhancing and developing the sense of personal power of individual members of social systems.     

Protecting older adults in the Israeli health system: Cross-cultural interactions involved in legal and social elder abuse interventions

ABSTRACT

In 2002 the World Health Organization published a categorical definition of “Elder Abuse,” but the relevant social and legal interventions differ markedly even among Western-oriented countries. This article compares and contrasts approaches to this widespread and very serious problem in the New York City and the Israeli health-care systems. In today’s world, the members of a family do not all necessarily live on the same continent, so professionals must be aware of the way things are done in countries other than their own. The differences in the interventions employed, or not employed, in these two specific systems highlight the need to understand not only how elder abuse is dealt with in each place, but the conceptual framework that governs it. The present article can serve as a guide for American professionals and others concerned with the problems of elder abuse who function within the Israeli health care system.     

A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

Suicide Crisis Syndrome: A review of supporting evidence for a new suicide‐specific diagnosis

Suicide is a major public health problem, and suicide rates are still on the rise. Current strategies for identifying individuals at risk for suicide, such as the use of a patient's self‐reported suicidal ideation or evidence of past suicide attempts, have not been sufficient in reducing suicide rates. Recently, research groups have been focused on determining the acute mental state preceding a suicide attempt. The development of an acute suicidal diagnosis, the Suicide Crisis Syndrome (SCS), is aimed at capturing this state to better treat individuals. The SCS has five main evidence‐based components—entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The SCS may provide clinicians with the ability to identify individuals who are experiencing an acute pre‐suicidal mental state, regardless of their self‐reported suicidal ideation. Future research leading to the incorporation of this diagnosis into clinical practice could improve the quality of care and reduce the personal, societal, and legal burden of suicide.     

Rethinking Professional Ethics in the Cost-Sharing Era

Changes in healthcare financing increasingly rely upon patient cost-sharing to control escalating healthcare expenditures. These changes raise new challenges for physicians that are different from those that arose either under managed care or traditional indemnity insurance. Historically, there have been two distinct bases for arguing that physicians should not consider costs in their clinical decisions—an “aspirational ethic” that exhorts physicians to treat all patients the same regardless of their ability to pay, and an “agency ethic” that calls on physicians to be trustworthy advisors to their patients. In the setting of greater patient cost-sharing, physicians' aspiration and agency roles increasingly conflict. Satisfactorily navigating the new terrain of consumer-driven healthcare requires physicians to consider these two roles and how they can best be reconciled so as to maximize quality of care while respecting the heterogeneity of patients' financial resources and willingness to pay.     

The Ethics of Organ Donor Registration Policies: Nudges and Respect for Autonomy

Governments must determine the legal procedures by which their residents are registered, or can register, as organ donors. Provided that governments recognize that people have a right to determine what happens to their organs after they die, there are four feasible options to choose from: opt-in, opt-out, mandated active choice, and voluntary active choice. We investigate the ethics of these policies' use of nudges to affect organ donor registration rates. We argue that the use of nudges in this context is morally problematic. It is disrespectful of people's autonomy to take advantage of their cognitive biases since doing so involves bypassing, not engaging, their rational capacities. We conclude that while mandated active choice policies are not problem free—they are coercive, after all—voluntary active choice, opt-in, and opt-out policies are potentially less respectful of people's autonomy since their use of nudges could significantly affect people's decision making.     

Psychosocial Predictors of Health Status and Health Care Costs among People with Fibromyalgia

The purpose of the present study was to examine the effects of psychosocial characteristics on health status and the relationship between health status and health care use and costs in a group of people with fibromyalgia (FMS) over a 1-year period. The participants were 600 members of a large health maintenance organization. Demographic characteristics (age, education, employment status, ethnicity and income), need variables (comorbid conditions and baseline health status), and psychosocial variables (self-efficacy, helplessness, coping, and depression) were examined. Better health status at baseline, use of emotion-focused coping, and higher self-efficacy predicted better health status the following year. Higher health care use at baseline, being Caucasian, being older, and having more co-morbid conditions predicted higher health care use at 1 year. Only health care costs at baseline predicted health care costs the following year. Our results indicate that health care use and cost tend to be stable. Intense interventions focused on changing patterns of health care use and methods for coping with the change need to be developed and tested.     

Public Health Communication Theory and Strategies for Interpersonal Violence Prevention

ABSTRACT

The article reviews experience and lessons learned from public health communication to identify promising strategies for interventions seeking to promote interpersonal violence prevention. A public health perspective highlights multiple levels of analysis in tandem with concomitant communication theory invoking social, institutional, community, and individual change processes. Points of emphasis include a long-term perspective for social change and the importance of achieving high levels of exposure to communication efforts. Alternative communication strategies such as social mobilization, the use of local media, and media advocacy may foster incremental legal reform and service provision, as well as transformed social expectations and norms.     

Imagining ethical globalization: The contributions of a care ethic

Approaches to global ethics have drawn on a number of diverse theoretical traditions, such as Kantianism and utilitarianism. While emerging frameworks contribute to a growing awareness of and interest in ethics within a global society, the values that they prioritize are not adequate for realizing a just, equitable and fair system of global governance. This article considers the possibilities of an alternative ethic—a feminist ethic of care—and explores how it can bear on present circumstances, including global inequity and injustice. This care ethic has been put forward as a viable normative approach to politics and policy. Little attention, however, has been paid to the potential of a care ethic within the globalization and ethics debate. This article illustrates how the values and corresponding principles of care, grounded in relationships and responsibilities, are essential to responding adequately to the current challenges of globalization. By examining the relevance of care in this context, the article seeks to broaden dominant ethical worldviews and contribute to the articulation of normative tools for examining globalization while at the same time avoiding the trappings of conventional universality—the abstract and a priori thinking typically associated with conceptions of global ethics.     

The Tarasoff Warning and the Duty to Protect

Summary

Since the case of Tarasoff v. Regents of the University of California, mental health professionals have had an explicit legal duty to warn potential adult victims of violence. Subsequent case law expanded this standard to a broader duty-to-protect. Primary health care providers are increasingly treating psychiatric patients for whom the duty to protect is applicable. However, these providers are often unaware of the legal, ethical, and clinical issues involved. Assessment of violence risk should include demographic, psychiatric, and social dimensions. Interventions include notifying law enforcement authorities, potential victims, and possible use of psychiatric hospitalization to prevent aggressive behavior. The duty-to-protect as a standard-of-care has been applied to several other clinical situations, including impaired driving capacity, high-risk HIV behavior, and child sexual abuse. The article includes a step-by-step clinical protocol for evaluation and intervention in dangerous situations.     

A School-Based,Primary Violence Prevention Program

Summary

This article presents findings from an evaluative study of a multidisciplinary violence prevention project jointly administered by a family practice clinic and junior high school in Santa Fe, New Mexico. The project team hypothesized that an intervention established on a public health model and aimed at enhancing adolescent self-esteem through cognitive and behavioral strategies would reduce the tendency to engage in violence of participating students. The project united health care personnel, social workers and legal profession-als in an effort to teach students specific cognitive tools for the reduction and avoidance of violent encounters. The experimental results do not reveal Project effectiveness in boosting self-esteem indicators among students, although the Project docs seem to have contributed to the control of students' behavioral aggression. Although a clear relationship between self-esteem and violent behavior is not demonstrated by the experimental results, the project study suggests that school-based, anti-violence programs based on a public health model can have a positive effect in the reduction of physical and verbal aggression among adolescents.     

Combining Patient Utility with Health Status Assessment to Improve Medical Decision Making

Physicians often use health status assessment tools to evaluate a patient's condition, then apply established guidelines to determine the most medically effective treatment. Yet additional criteria, such as the appropriateness of the treatment given the particular patient's preferences and attitude toward risk, are also highly relevant to quality care. While such preferences could be addressed via patient utility functions, their use in actual practice is somewhat limited because elicitation is often considered too burdensome for patients, unreliable, or redundant given other measures. For a small group of real patients who have suffered a stroke, we measure both traditional health status and patient utility for the current state to determine whether limited, focused utility assessment is a practical means of obtaining additional and relevant patient information. We find that utility assessment is perceived as reasonable and useful by patients, even when quite ill, and that utilities and health status are not redundant. In fact, investigating apparent inconsistencies between patient utility and observed health status can alert the physician to patient concerns and criteria not captured by more traditional measures. We propose an approach to medical decision making that uses both measures to improve patient–physician communication.     

The Family Peace Project

Summary

Intimate partner violence-assault by a spouse, ex-spouse, intimate friend or ex-friend-is the most common cause of injury for women and a serious public health problem. As a result, the American Medical Association has recognized physicians' ethical obligation to diagnose and treat partner violence, and called for new models of training. In this article, we review literature on the health care system's response to domestic violence. We then describe the Family Peace Project, a community oriented model for training health care professionals to identify, treat and prevent partner violence in primary health care settings. This training program provides knowledge, clinical skills and a sense of professional empowerment. Unique features of this program include: involvement of community mentors (survivors of family violence) as program faculty; training in specific clinical skills and protocols for screening, assessment and intervention; a hands-on assessment of community resources; coinmunity service; and, creation of an award winning web site to promote dissemination of the training program.     

Ethical Challenges Arising in the COVID-19 Pandemic: An Overview from the Association of Bioethics Program Directors (ABPD) Task Force

Abstract

The COVID-19 pandemic has raised a host of ethical challenges, but key among these has been the possibility that health care systems might need to ration scarce critical care resources. Rationing policies for pandemics differ by institution, health system, and applicable law. Most seem to agree that a patient’s ability to benefit from treatment and to survive are first-order considerations. However, there is debate about what clinical measures should be used to make that determination and about other factors that might be ethically appropriate to consider. In this paper, we discuss resource allocation and several related ethical challenges to the healthcare system and society, including how to define benefit, how to handle informed consent, the special needs of pediatric patients, how to engage communities in these difficult decisions, and how to mitigate concerns of discrimination and the effects of structural inequities.     

Dimensional analysis of a categorical diagnostic interview: the DICA-IV

The aim of this study is to obtain dimensions from a categorical diagnostic interview. 512 children aged 8 to 17 attending public centers for children's mental health and presenting some form of psychological disorder were interviewed with the "Diagnostic Interview for Children and Adolescents" (DICA-IV). Analysis of the principal components indicate that a two-dimensional model (externalizing-internalizing) satisfactorily explain the data collected from the children and their parents. The data from the adolescents are better represented by a three-dimensional model (attention problems-internalizing-antisocial behavior). The factor scales show good internal consistency and significantly relate to other criteria of psychopathology and incapacity (concurrent validity). These results show that it is possible to use DICA-IV to obtain categorical and dimensional indicators simultaneously. The latter are particularly sensitive for measuring changes over the course of disorders.