The Impact of Economic Globalisation on Health

The analysis of the impact of economic globalisation on health depends on how it is defined and should consider how it shapes both health and health policies. I first discuss the ways in which economic globalisation can and has been defined and then why it is important to analyse its impact both in terms of health and health policies. I then explore the ways in which economic globalisation influences health and health policies and how this relates to equity, social justice, and the role of values and social rights in societies. Finally, I argue that the process of economic globalisation provides a common challenge for all health systems across the globe and requires a broader debate on values, accountability, and policy approaches.     

Attention-Affect Check List: A self-report measure of acute mental stress

Given a hint from Lang, Bradley, and Cutbert's (1997) defense cascade, two cognitive processes, instead of passive versus active behavioral coping, which seem to have differential effects on the provocation of vascular- versus cardiac-dominant reaction pattern during mental stress were advocated: attention (Attent) versus unpleasant affect (UnplAff). Based on this notion the Attention-Affect Check List (AACL) was developed as a self-report measure. In addition, items on uncontrollability (Uncontr) were prepared for the purpose of checking whether heightened Attent and UnplAff are accompanied by alterations in Uncontr. Two hundred and eighty-four students underwent two kinds of mental stress, which seemed to specifically heighten Attent and UnplAff. Four factors with four items each were extracted from the AACL item pool: concentrated and allocated Attent, UnplAff, and pleasant affect. Also, one factor with four items was extracted from the Uncontr item pool. For both the mental stresses, each scale, although very brief, had quite reasonable alpha reliability. Accountability of each scale for the total variance was reasonably high. Some problems are discussed in relation to the validity of AACL.     

Work values among the unemployed: changes over time and some gender differences

Work involvement (psychological identification with work in general) has generally been considered as a stable, dispositional characteristic, although some studies of unemployment have contradicted this view. Using longitudinal data from a Swedish representative sample (n= 888), this study examines employment status change (e.g. from work to unemployment) and work values development in a 15-month time period. Furthermore, the relationship between employment status change and well-being is explored, with a special focus on the roles played by work values and gender differences. Results indicated that work values are fairly stable over 15 months. As expected, the long-term unemployed (mostly active job seekers) had higher measures of work involvement after 15 months. Further, no gender difference was found with regard to work involvement but females were more likely to agree that there is an entitlement to work. Becoming unemployed was associated with negative health effects, but only among unemployed men.     

Spirituality Predicts Health and Cardiovascular Responses to Stress in Young Adult Women

The primary focus of this study was to investigate the roles of spirituality and religiosity in self-reported physical health, and to determine whether there is an association between an individuals spirituality and cardiovascular responses to two stressors. Fifty-two females participated in both a betrayal interview and a structured interview, during which blood pressure and heart rate were monitored. Spirituality, as assessed by the Spiritual Well-being Scale, was associated with perceived stress, subjective well-being, and medication use. The Existential Well-being subscale predicted fewer physical health symptoms and was associated with lower mean heart rate and decreased heart rate reactivity. The Religious Well-being subscale was associated with reduced systolic blood pressure reactivity in response to the structured interview. These findings suggest that spirituality may have a salutary effect on health, even in a fairly young sample. While previous studies have predominantly reported that religion, as well as spirituality, have a health protective effect, this study did not find strong support for that conclusion. Religiosity in this age group may still be undergoing developmental maturity, which may explain the lack of relationships to health.     

Ethnic variations in the initial phase of mental health treatment: a study of Sami and non-Sami clients and therapists in northern Norway

Several studies indicate that mental health and mental health service vary with ethnicity. Ethnically linked social differences affect these results. We examined the multiethnic population in northern Norway where social inequalities between the Sami and the non-Sami population are not prominent. Clients (N=347) and therapists (N=32) in outpatient treatments reported demographics, ethnicity and the therapeutic alliance. Clients also reported pretreatment psychosocial status, service utilization and the type of help requested. Therapist recorded clinical and diagnostic assessments and treatment plans. The Sami and non-Sami client groups were similar in demographics and pretreatment psychosocial characteristics. However, the therapists prescribed more sessions and more socially focused interventions when clients were Sami. Verbal therapy was more often used by the non-Sami therapists. Alliance ratings were positively correlated only between Sami therapists and their clients, and Sami therapists rated the largest initial clinical improvement. Clinics located in the high Sami density areas offered their clients more therapy sessions, than in clinics in the high non-Sami density areas. Ethnic similarity between client and therapist were associated with more frequent use of medication and less frequent use of verbal therapy.     

Hypochondriasis Among Patients with Multiple Somatoform Symptoms—Psychopathology and Outcome of a Cognitive-Behavioral Therapy

As hypochondriasis often occurs with somatization, patients with somatization disorder plus hypochondriasis were compared to patients with somatization syndrome alone regarding psychopathology, patterns of physical symptoms and outcome of a cognitive-behavioral inpatient treatment. A sample of patients with DSM-IV hypochondriasis and multiple somatoform symptoms(N = 27) and a matched sample of patients with multiple somatoform symptoms but without hypochondriasis (N = 27) were assessed. All subjects obtained a cognitive-behavioral treatment for somatization and hypochondriasis. Assessment took place at admission and at one-year follow-up. Only a few differences between the groups were found: Hypochondriacs suffered more often from abdominal pain, and they reported a higher intolerance of bodily complaints. At follow-up, all outcome variables improved significantly. High effect sizes were found for the reduction of symptoms and the mean number of visits to the doctor. The specific effect on health care use highlights the socioeconomic relevance of these results.     

Outcomes for Children and Adolescents After Residential Treatment: A Review of Research from 1993 to 2003

The focus of this research review is to determine what factors increase the likelihood that positive individual and systemic changes occur for children and adolescents following discharge from residential treatment. Residential treatment outcome studies from 1993 to 2003 that fulfilled predetermined criteria were located through 4 on-line databases using key word combinations. The research selected was: (a) 7 studies that measured outcome immediately upon completion of treatment and discharge, and (b) 11 studies where outcome progress was assessed at one or more follow-up dates after discharge. Results showed that children and adolescents with severe emotional and behaviour disorders can benefit and sustain positive outcomes from residential treatment that is multi-modal, holistic and ecological in its approach. Similar to the clinical child psychotherapy research, conclusions must be tempered due to the limited number of studies and methodological weaknesses. Future considerations highlight how research results can more realistically reflect intervention effectiveness when elements of the ecological and systemic landscape of care are addressed.     

Parenting Competency Across Pregnancy and Postpartum Among Urban Minority Women

Taking a life-course perspective, we explored the sense of parenting efficacy during the pregnancy-postpartum transition among a group under-represented in much of adult developmental research, minority women. Our intent was to describe the women's report of parenting competency in a major life transition occurring within the context of an impoverished urban environment. We also explored associations with depression, social support, and life events. One hundred and eighty-two African-American and Hispanic mothers at community health centers in low-income urban areas completed measures early in the third trimester and again at 3 months postpartum. Across time, the levels of reported parental efficacy and satisfaction increased while depressive symptoms decreased. Negative life events and levels of depressive symptomatology differentially influenced women's experience of parenting satisfaction and efficacy feelings before and after their babies were born.     

Mental Health and Other Service Use by Youth in Therapeutic Foster Care and Group Homes

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services.