加强管理，改善流动人口卫生保健服务利用

为改善流动人口卫生保健服务利用水平,通过现场调查、焦点组访谈和二级资料提取等定性定量研究方法收集上海流动人口卫生保健服务利用情况的资料。在对上海流动人口卫生保健服务利用现状、存在的问题和利用障碍进行了分析的基础上,提出了加强管理,改善流动人口卫生保健服务利用的8项建议。     

四城市流动人口管理者意向调查分析

随着经济的快速发展,流动人口数量急剧增加,给城市发展带来了一定影响,流动人口的管理问题越来越得到各级政府的重视.通过对4城市流动人口管理者进行意向调查分析,了解目前流动人口管理存在的主要问题,分析影响流动人口管理的主要障碍,提出改善流动人口管理的建议.     

关于我国流动人口公共卫生管理的思考

大量的流动人口从农村流入城市,在推动城市社会、经济发展的同时,也带来了诸如流动人口治安管理、子女教育和卫生保健等问题。通过对流动人口公共卫生管理中存在主要问题分析,提出了改善流动人口公共卫生管理构建和谐社会的5项建议。     

医学科学,卫生保健与卫生革命

四、令人深思的困惑一个令人深感不安的困惑是：尽管第二次卫生革命的几十年耗费了大量人力、物力和财力，也取得了赫赫成果，但构成第二次卫生革命主要内容的慢性病、老年病、非感染性疾病，其发病率、病死率，并不见下降，反而甚至节节上升。请看以下一些事实。据《中国...     

理智而现实的选择--面临新世纪的卫生保健服务

新世纪的卫生保健服务,面临的将是不断增长的健康需求、日益昂贵的费用和难于对付的现代文明病的客观形势,因而必须全面把握卫生保健改革的目标,将满足健康需求,所有制费用的过快增长和控制现代文明病的蔓延三者有机地结合起来,融资、医疗保险和提供服务等方面推行多层或多层体制,才能收到较为理想的效果。任何只考虑某一方面的需求和机能（如市场）的做法,都可能使卫生保健服务陷入更严重的困境。     

流动人口传染病社区防控的探讨

流动人口是人群总体中处于经济和社会弱势地位的一个特殊群体,其规模不断增加,但因其经济水平低下、卫生意识薄弱、生活环境差、缺乏医疗保障、预防保健服务可及性差,已成为传染病流行过程中的脆弱人群,其发病率较常住人口高,已成为公共卫生工作中不容忽视的群体。通过查阅文献概括了流动人口传染病流行现状,与流动人口密切相关的重大传染病发病趋势,归纳分析流动人口传染病社区防控的必要性、可行性,提出建立行政组织与社区医院相联系的网络体系、加强社区卫生建设的对策。     

医学科学,卫生保健与卫生革命（待续）

当代卫生革命的任务是什么？当代医学科学、卫生保健服务与当代卫生革命的任务相适应吗？一、疾病流行特点与卫生革命不同时期卫生革命的任务与目标，决定于不同时期健康需求及疾病流行的规律与特点。从人类历史发展的情况看，疾病的滋生、蔓延与流行特点，总是与人类社会...     

不同语境下的初级卫生保健

初级卫生保健一词在国内文献中涵义不同,研究发现《阿拉木图宣言》中的初级卫生保健更多的具有卫生体系变革的涵义,强调公平性、多部门合作、社区参与、适宜技术和适宜人力的原则;选择性初级卫生保健则以推广具有成本效益的卫生干预措施为重点;国内政策语境下的初级卫生保健则更多的是具体的卫生服务内容。     

我国农村初级卫生保健制度发微

集中梳理和总结有关中国农民初级卫生保健,特别是农村卫生投入和补偿机制、农村公共卫生和预防保健的文献,结合实地调研中发现的问题和矛盾,分析当今中国初级卫生保健的倾向、面临的问题,和当前我国卫生资源科学、合理利用以及可持续发展的滞碍所在,从理论与实证研究的角度提出未来的工作方向和政策建议.     

我国农村初级卫生保健制度发微

集中梳理和总结有关中国农民初级卫生保健,特别是农村卫生投入和补偿机制、农村公共卫生和预防保健的文献,结合实地调研中发现的问题和矛盾,分析当今中国初级卫生保健的倾向、面临的问题,和当前我国卫生资源科学、合理利用以及可持续发展的滞碍所在,从理论与实证研究的角度提出未来的工作方向和政策建议。     

Mental Health,Culture and Spirituality: Implications for the Effective Psychotherapeutic Care of Australia's Ageing Migrant Populations

SUMMARY

In this essay, attention is given to discussing the notions of and influences of culture, mental health and spirituality. Research shows that people who came to Australia either as immigrants or refugees are at risk of suffering a disproportionate incidence of mental problems relative to the rest of the Australian population. Older male immigrants are particularly at risk. A key variable influencing the mental health of immigrants/refugees in Australia is the social conditions in which they live. Another largely unrecognised variable influencing mental health is spirituality. The extent to which the expression of spirituality promotes mental health and healing, however, will depend on cross-cultural perceptions of what spirituality is, and how it influences mental health, illness and recovery. Whatever the perceptions of spirituality, it is important to understand that its roots are cultural, and its influence is on meaning construction. Meaning construction, in turn, is itself culturally mediated and framed. Given this, it is crucial that culture-what it is and how it influences human experience-is understood by health professionals if they are to be able to provide meaningful and therapeutically effective care to culturally diverse people and their mental health problems. A central aim of this essay is to facilitate this understanding.     

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients. This article is based in part on a presentation by the first author at the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC) in May of 2007 in Minneapolis, Minnesota.     

Behavioral Health Services Influence Medical Treatment Utilization Among Primary Care Patients with Comorbid Substance Use and Depression

Although research has shown benefits of integrating psychological care in primary care settings, it is unclear how this form of treatment impacts individuals with comorbid substance use and depression. The findings are also mixed concerning how frequently this comorbid population seeks primary care services. This study examined the associations between substance use, depression, and medical treatment utilization among 224 primary care patients. The aim of the investigation was twofold. First, to determine if depression increases medical treatment utilization among patients with substance use disorders; second, to evaluate if behavioral health treatment reduces medical service utilization. A moderated mediation model with bootstrapping analyses revealed that depression strengthened the relationship between substance use and primary care treatment utilization (both medical and behavioral health). The model also indicated that behavioral health services were associated with fewer primary care visits for individuals with comorbid substance use and depression. Clinical and social implications are discussed.     

Health Risk Behaviors and Their Relationships to Health Care Utilization Among Veterans Receiving Primary Medical Care

This paper reports the findings of a behavioral health risk screening form and examines the interrelationships among behavioral risk factors and health care utilization. Participants were 1,000 veterans who completed a brief self-report questionnaire assessing affective distress and behavioral health risk factors while they waited to see their primary care provider. Participants reported a mean level of affective distress in the mild range on a scale of 0 to 20 (M = 6.4, SD = 4.95), and 22.4% reported moderate or high levels of affective distress. Fifty percent of the sample denied alcohol use; 5% of the men and none of the women reported a pattern of use that met established criteria for at-risk drinking. Twenty-six percent of the sample reported current tobacco use, 45% acknowledged concerns about diet and/or weight, and 54% reported concern about pain. These factors were largely significantly intercorrelated and several were related to indices of health care utilization. It was concluded that veterans receiving health care in primary care settings report significant levels of affective distress and other health risk behaviors and that the presence of these factors is associated with increased use of the health care system. These data encourage increased efforts to identify these factors and to develop behavior change interventions.     

School-Based Mental Health Services: Definitions and Models of Effective Practice

ABSTRACT

School-based mental health services are those delivered by school-employed and community-employed providers in school buildings. With the implementation of provisions of the Patient Protection and Affordable Care Act (2010) that funds school-based health centers, school-based mental health services could become more broadly available in communities throughout the United States. Playing a pivotal role in promoting models for school-based services that maximize benefits to children and adolescents while making efficient use of communities' mental health resources are school psychologists. School psychologists, who recognize and respect the separated development of school and community mental health professions, can foster school–agency partnerships to coordinate children's mental health services that are comprehensive, child centered, family focused, and culturally competent. In this article, we provide three case examples using the Participatory Culture-Specific Intervention Model (B. K. Nastasi, R. B. Moore, & K. M. Varjas, 2004 Nastasi, B. K., Moore, R. B., & Varjas, K. M. (2004). School-based mental health services: Creating comprehensive and culturally specific programs. Washington, DC: American Psychological Association. [Google Scholar]) as exemplars for the implementation of community partnerships providing comprehensive culturally and contextually relevant school-based mental health services.     

Out of the Loop: (In)access to Health Care for Migrant Workers in Canada

Drawing on a survey of nearly 600 migrant farm workers in Ontario, Canada, we investigate the ways in which the liminality of temporary migrants is both conditioning and consequential in terms of health for these migrants. In particular, we demonstrate how the liminality inherent in managed temporary migration programmes creates the conditions for heightened vulnerability, which also have consequences for the health of migrant workers and their access to care. We discuss common barriers to health care access experienced by migrant workers, including employer mediation, language differences, and hours of work.     

Catholic Social Teaching and the Economics of Health Care Management

The author considers the issue of what it is for a health careinstitution to be intentionally Christian. He begins with areview of Catholic social teaching, and considers how this perspectiveis shaping Catholic thought and action regarding health caremanagement and public policy reform. He then proposes some standardsfor intentionally Christian institutions.     

How Can Ethics Support Innovative Health Care for an Aging Population?

The rapidly expanding aging population presents an urgent global challenge cutting through just about every dimension of worldly life, including the social, political, cultural, and economic. Developing innovations in health and assistive technology (AT) are poised to support effective and sustainable health care in the face of this challenge, yet there is scant (but growing) discussion of the ethical issues surrounding AT for older persons with dementia. Demands for ethical frameworks that can respond to frontline dilemmas regarding AT development and provision, and how the needs of aging persons themselves are defined throughout this development process, are increasing. This article suggests that fulfilling the promises of AT to provide effective and ethically informed solutions may demand shifting away from standard bioethical analyses that centralize the principle of respect for autonomy. An autonomy-centric paradigm is dubiously equipped to theorize the foundational ethical issues in dementia care and to effectively guide AT development and implementation. An agency-centered approach to dementia care, which could engage more adaptively with the perspectives and choices of older persons themselves while offering strong support to AT research and stakeholders, may offer an attractive alternative.     

The Starting Early Starting Smart Integrated Services Model: Improving Access to Behavioral Health Services in the Pediatric Health Care Setting for At-Risk Families with Young Children

We evaluated the Starting Early Starting Smart (SESS) national initiative to integrate behavioral health services (parenting, mental health, and drug treatment) into the pediatric health care setting for families with young children. Data are presented from five pediatric care (PC) sites, drawing from families at risk due to demographic and behavioral health factors, with infants less than 12 months of age (n = 612). Families were randomly assigned to either the SESS program or a standard care Comparison group. We utilized longitudinal analyses to estimate differences in utilization rates for parenting, mental health, and drug treatment over 6 follow-up time points (3, 6, 9, 12, 15 and 18 months). Our findings indicate that SESS caregiver participants were 4.6 times (p < 0.001; CI = 3.33–6.26) more likely to receive parenting services, 2.1 times (p < 0.001; CI = 1.48–2.86) more likely to receive outpatient mental health treatment, and 1.8 times (p = 0.025; CI = 1.08–3.14) more likely to receive drug treatment than Comparison group participants. Our results demonstrate the success of the SESS program in coordinating and improving access to behavioral health services for high-risk caregivers within the pediatric health care setting and highlight the importance of continuing to focus public health policy on the behavioral health care needs of families with young children.