印度农村医疗的现状与对策

自印度独立以来,政府就致力于采取各种有力措施来改善人们的健康情况并已卓见成效。尽管印度政府采取了一系列的发展政策,经济、地区发展不平衡及男女不平等还是为医疗部门带来了巨大的挑战。分析印度政府在农村所面临的问题以及为解决这些问题政府颁布的新政策。     

结核病控制应加强机构间协作

结核病控制工作是一个需要公共卫生机构与医疗机构密切协作的艰巨任务。然而,长期以来两者之间工作目标的不一致,已经影响了结核病人的转诊和有效管理。从组织学的角度探讨两者之间的关系的现状、现有结核病控制制度的作用有限性和组织创新的必要性,并对建立两者之间良好的关系,促进结核病控制工作提出了建议。     

Sins of the American Empire and Pastoral Responses

This article describes attributes of the American Empire and addresses characteristic sins—pride, sloth, greed, and idolatry—that are necessary for maintaining the domestic and foreign policies aimed toward expanding the economic and military power of the United States. In particular, I claim that theo-political narratives and rituals extant in U.S. culture are internalized, structuring our collective psyches and shaping both our wills and actions. Pride, sloth, greed, and idolatry signify the distortion of will, giving rise to actions that result in harm and alienation. To address this reality, several pastoral strategies are depicted.

A Universally Particular Psychology? A Feminist Practical Theological Exploration of <Emphasis Type="Italic">Indigenous and Cultural Psychology</Emphasis>

The newly published volume, “Indigenous and Cultural Psychology: Understanding People in Context” (2006) seeks to further understandings of human behavior with an indigenous psychology that places culture and context in the foreground of its methods, practices, and analysis. As such it represents a significant development in its field, and is important to practical theologians with their attention to context, culture, and the lived religious practices of persons and communities. This article offers a critical review of the book from the standpoint of feminist practical theology, in an effort to further and support the agenda of indigenous psychology. After describing the importance of indigenous psychology for the work of practical theologians, I consider the volume’s chapter on indigenous Filipino psychology (chapter five by Rogelia Pe-Pua) as paradigmatic of the strengths of an indigenous approach put forward in the larger volume. Last, I critically consider two key paradoxical tensions present in the volume’s articulation of indigenous psychology: the tension between universality and particularity, and the tension between indigeneity and critical gender analysis.     

Infant care from infants' viewpoint: the views of some professionals

Debate about infant care tends to focus on still unresolved questions about whether or not day care is harmful, while research studies often confine care options to an unrealistic axis of choice between group care and mother care. Research that delineates constituents of day care quality in relation to measurable outcomes for different groups of children is urgently needed and should be based on a broader view of infant care options. A postal opinion survey sought the confidential views of members of an international organization of infant mental health professionals as to the kinds of care they considered likely to be best for infants from birth to 36 months, assuming that all types of care were of equally high quality and availability. Surprisingly lengthy periods of care by mothers were consistently endorsed; fathers were almost entirely disregarded as principal or joint caregivers; all forms of family care were endorsed over all forms of purchased care, but all forms of individual care were preferred to full-day group care for all age groups and to half-day group care up to the age of 2. The patterns of care judged by these respondents as likely to be best for infants are very different from those which most infants experience now, and from those which policy- and opinion-makers, practitioners and parents aspire, publicly at least, to provide for infants in the future. ©1997 John Wiley & Sons, Ltd.     

Do Health Care Workplaces Affect Treatment Environments?

Previous research has demonstrated that characteristics of the health care workplace influence staff outcomes such as morale and burnout, but the potential effect of health care workplaces on the treatment environment has been little studied. Building on a model proposed by Schaefer and Moos (1993), we propose that the workplace factors of supervisory work environment (e.g. support from supervisors, managerial control) and programme philosophical orientation (e.g. disease model of addiction, psychosocial learning model of addiction) predict four treatment environment elements: patient autonomy, staff control, staff sensitivity, and patient alienation. Multiple regression analysis of data drawn from a survey (response rate = 86%) of 327 staff members at 15 Veterans Affairs (VA) inpatient substance abuse treatment programmes revealed that greater managerial control over staff predicted greater patient alienation, lower staff sensitivity towards patients, and greater staff control over patients. Stronger disease model programme orientations predicted less patient alienation and greater staff sensitivity, whereas stronger psychosocial model programme orientations predicted less staff control. These results suggest that health care workplaces may influence treatment environments. Implications for further research and practice are discussed. © 1997 John Wiley & Sons, Ltd.     

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.     

Dismantling institutional racism: theory and action

Despite a strong commitment to promoting social change and liberation, there are few community psychology models for creating systems change to address oppression. Given how embedded racism is in institutions such as healthcare, a significant shift in the system's policies, practices, and procedures is required to address institutional racism and create organizational and institutional change. This paper describes a systemic intervention to address racial inequities in healthcare quality called dismantling racism. The dismantling racism approach assumes healthcare disparities are the result of the intersection of a complex system (healthcare) and a complex problem (racism). Thus, dismantling racism is a systemic and systematic intervention designed to illuminate where and how to intervene in a given healthcare system to address proximal and distal factors associated with healthcare disparities. This paper describes the theory behind dismantling racism, the elements of the intervention strategy, and the strengths and limitations of this systems change approach.     

Spiritual Tools for Enhancing the Pastoral Visit to Hospitalized Patients

The tradition of visiting the sick is a practice that brings comfort to patients who are suffering, offers prayers for healing, and keeps the connection with family and community alive. It is a practice recognized from ancient times through today, one which underscores the mission of the field of Pastoral Care. This paper describes the creative use of multi-sensory spiritual tools, such as music, singing, personal prayer, psalms, and traditional texts, to enhance the sick visit to the hospitalized patient. This brief structured model is replicable and teachable to lay and professional caregivers. Both patient, family members, and caregivers can benefit from sharing in these moments of inner spiritual attunement and connection with others. Israela Meyerstein, LCSW-C, LMFT, is a social worker and family therapist in private practice in Baltimore, Maryland. An Approved Supervisor for the American Association for Marriage and Family Therapy, Ms. Meyerstein has trained therapists of all disciplines and has published over two dozen articles relating to Family therapy, medical issues, and spirituality. She is co-founder of the Baltimore Jewish Healing Network. Correspondence to Israela Meyerstein, Imeyerstein@hotmail.com. Gila Ruskin has served as a congregational rabbi, psychiatric hospital chaplain, adult and day school educator, and pastoral counselor. Rabbi Ruskin currently teaches Bible, Holocaust Studies, and Creative Writing at the St. Francis Academy in Baltimore, Maryland. She is co-founder of the Baltimore Jewish Healing Network.     

Behavior Problems, Academic Skill Delays and School Failure Among School-Aged Children in Foster Care: Their Relationship to Placement Characteristics

We describe the level of behavior problems, academic skill delays, and school failure among school-aged children in foster care. We also examine how behavior problems are associated with academic problems, and explore how these outcomes are related to children's placement characteristics. Foster parent and child home interviews, as well as teacher telephone interviews were conducted from a randomly selected sample of 302 children aged 6 through 12 years living in out-of-home placement. Interviews included standardized screening measures. Results showed that 27% of the children scored in the clinical range for a behavior problem, and 34% were rated as having at least one behavior problem in the classroom. Twenty-three percent of the children had severe delays in reading or math, 13% had repeated a grade, and 14% had a history of school suspension and/or expulsion. Behavior problems by foster parent report were related to child suspension and/or expulsion from school, but were not associated with severe academic delays or grade retention. Placement characteristics were only sometimes related to these outcomes. Future studies examining the mental health and educational needs of this population should take into account the child's sociodemographic and placement characteristics.