循证医学与人文关怀

本文从循证医学发展和应用过程的角度分析了循证医学所包涵的人文精神和人文关怀。文章介绍了循证医学的人文底蕴,针对医学实践中人文关怀的缺失,着重探讨了循证医学的发展对医学人文关怀内涵的丰富和发展。文章最后就怎样在循证医学的实践中更好地实现人文关怀提出几点建议。     

Analyse interlocutoire d’une plainte exprimée par une équipe mobile de soins palliatifs

This article points out the merits of conducting an interlocutory analysis of a group meeting held between two administrations of a questionnaire. Here, the Company Climate Questionnaire was filled out individually by the members of the group before and after the meeting. Changed attitudes toward the supervisory staff were observed after the discussion. All participants were members of a mobile palliative care team at a university hospital. The verbal interaction analysis allowed us to identify the collaborative facet of the complaint that surfaced, and to determine what inter - subjective processes arising during the group discussion triggered the expressed changes of opinion.     

Psychosocial work factors, physical work load and associated musculoskeletal symptoms among home care workers

This study was based on a questionnaire and included a group of home care workers (HCW) (n = 305) and a reference group of municipal employees (n = 694). The relationship between the work environment and musculoskeletal symptoms was analysed. The HCW were less satisfied with their control over their work and stimulus from their work and had a higher physical work load and prevalence of musculoskeletal symptoms, compared with the reference group. The Rate Ratio (RR) of neck and shoulder symptoms among HCW was 83 and 54 %, respectively, higher among those reporting a "high" psychological work load compared with those reporting a "low" load. The highest RR for a single risk indicator was 2.5, and this concerned low-back symptoms among HCW who often worked with twisted postures. A combination of "poor" psychosocial work environment and "high" physical work load produced the highest RR for work-related neck (RR = 2.57) and shoulder (RR = 2.13) symptoms.     

Building a research base for community services for children and families: What we know and what we need to learn

We examine the knowledge base for community-based mental health services for youth and their families. A brief historical perspective on the development of community services is presented, and the fundamental components of a comprehensive child mental health service system are described. Outcome studies for service components as well as the service system as a whole are summarized. Research related to the context of treatment, i.e., service setting, cost, is presented. The authors conclude that a research base for child and family services is emerging, but there is still a paucity of well designed studies that address the complexities of a community-based system as well as the critical outcome questions that need to be addressed. Finally, promising service system developments are described and recommendations for future research are presented.     

A role for clinical psychology in health care and policy concerning the physical environment

Some persons adversely react to specific environments, while others are impervious or actually thrive. Medical attention often overlooks such sensitivities to the physical environment. Such sensitivities, including phobias and seasonal affectivity, fall within clinical psychology's purview. A theoretical/clinical approach called the Synchronous Systems Model, which defines and uses individual differences in people and in settings, could serve medical health care and policy. When specific people are matched appropriately with specific treatments within the most propitious settings, cost effectiveness and medical efficacy rise. Such documented accountability could make clinical psychologists central to triage of medical services as well as health care policy in these days of the shrinking health care dollar. The Synchronous Systems Model provides theory, supportive data, and clinical assessment devices to strengthen clinical psychology's role in medical settings.     

Teaching psychological knowledge and skills to family physicians

Psychological problems (e.g., anxiety, depression, substance abuse) are prevalent in primary care medical settings. Family physicians (FPs) treat more patients than any other primary care medical specialists. Thus, FPs can play an extremely important role in providing psychological services to their patients. In contrast to other specialists (e.g., internists, obstetricians), FPs are required to complete behavioral science training in their residencies. In this paper, we describe standard undergraduate, graduate, and postgraduate training of FPs. We present our unique program for teaching psychological principles and skills to family practice residents at the University of Kansas Medical Center. And finally, we introduce an instrument, the Interview Rating Scale (IRS), for evaluating the interviewing skills of physicians and residents.     

Effects of Concerns About Child Care Among Single, Employed Black Mothers with Preschool Children

This study investigated whether differences in child care arrangements and mothers' attitudes about leaving their child in nonmaternal care were associated with maternal psychological well-being and perceptions of children in a sample of single, employed, low-income, Black mothers who were former welfare recipients. Feelings of discomfort with regard to nonmaternal care were associated with higher levels of maternal depressive symptomatology, which, in turn, predicted more negative perceptions of children. Preference for employment and increased working hours were associated with greater life satisfaction. Maternal education and the gender of the child were important moderating variables. Type of child care arrangement was nonsignificant. Policy implications are discussed.     

L’espoir dans la maladie chronique : représentations sociales de l’espoir chez les patients et soignants

Hope has a significant place in many literatures and most recently in health context. Nevertheless, there is still little research describing the distinct concepts and representations of hope in patients’ population. Hope is defined as perceived capability to derive pathways to desired goals, and motivate oneself via agency thinking to use those pathways. The main objective of this study is to explore the representation of hope, in the context of chronic disease, for both patients and health providers. For that purpose, we conducted the present study considering the social representation approach. The sample consisted of 67 chronic disease patients (mean age = 51.13 years; SD = 19.05; 68.70% female), 83 health care professionals (mean age = 35.32 years; SD = 11.49; 74.70% female) and 103 individuals from the general population (mean age = 30.41 years; SD = 13.85; 64.10% female). They completed two free associations task: write “everything that comes into your mind when you think about hope”, one in general and one in disease context. Free associations allowed us to identify shared conceptions of hope as well as intergroup variations in these representations. Associations with the word of hope produced by our respondents were depending on (a) the context (hope in disease or hope in general), and (b) the type of participant (patient, healthcare professionals or individuals from the general population). The results first indicate that hope, for all participants and whatever the context, refers to the beliefs of positive issues and perspectives. Moreover, dealing with a chronic disease seems to create, for the patients, a very specific representation of hope. It appears that when disease becomes serious and persistent, and when patients need to deal with uncertainty, hope is mainly described as a coping strategy, determined by specific objectives and resources.     

Use of a reference group in researching children’s views of psychotherapy in Malta

This paper explores the process and outcomes of a children’s reference group within the context of child psychotherapy research in residential care. The reference group was set up to consult children about the design of a research project which seeks to evoke, represent and understand children’s views of psychotherapy. No work to date has explored the experience of reference groups in the context of child psychotherapy in residential care in Malta. The paper contextualises the research within the literature on reference groups in child research, which identifies the potential of reference groups as a participative and co-reflexive activity which can inform research design. The paper critically examines the nature and conduct of the reference group by acknowledging the specific context of this work rather than assuming this is necessarily positive. It does so by specifying and evaluating the outcomes of the reference group in line with its aims. The paper draws on the recordings of the reference group meetings and reference group field notes taken by the researcher as key data which were thematically analysed. The main outcomes of the reference group include children’s contribution to the design of data collection methods especially in terms of not relying only on words during data collection. Children also identified key ethical issues from the point of view of young psychotherapy service users, especially in relation to issues of trust within a residential care context. Children also reviewed and appraised research information material. The reference group process drew from the researcher’s and participants’ contexts and contributed significantly to the researcher’s reflexive process especially in terms of acknowledging his power and positioning as an adult and his dual role as a practitioner/researcher.