巴西医疗保障体系

从巴西医疗保障体系的建立、资金筹集和使用等方面介绍巴西医疗保障体系,重点关注巴西全民统一医疗制度。鉴于巴西与我国在卫生系统绩效和医疗保障制度改革中所面临的相似挑战,试图通过对巴西医疗保障体系比较详细地介绍及与我国进行简单的对比,总结成功经验、吸取教训为我国建立全民覆盖的医疗保障体系提供借鉴和参考。     

Participatory Organizational Change in Community-Based Health and Human Services: From Tokenism to Political Engagement

Community psychologists have long worked with community-based human service organizations to build participatory processes. These efforts largely aim at building participatory practices within the current individual-wellness paradigm of human services. To address collective wellness, human service organizations need to challenge their current paradigm, attend to the social justice needs of community, and engage community participation in a new way, and in doing so become more openly political. We use qualitative interviews, focus groups, organizational documents, and participant observation to present a comparative case study of two organizations involved in such a process through an action research project aimed at transforming the organizations’ managerial and practice paradigm from one based on first-order, ameliorative change to one that promotes second-order, transformative change via strength-based approaches, primary prevention, empowerment and participation, and focuses on changing community conditions. Four participatory tensions or dialectics are discussed: passive versus active participation, partners versus clients, surplus powerlessness versus collective efficacy, and reflection/learning versus action/doing.     

Re-conceptualizing the Factor Structure of the Brief Multidimensional Measure of Religiousness/Spirituality

Rationale This study attempted to differentiate statistically the spiritual and religious factors of the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS), which was developed based on theoretical conceptualizations that have yet to be adequately empirically validated in a population with significant health disorders. Participants One hundred sixty-four individuals with heterogeneous medical conditions [i.e., brain injury, spinal cord injury (SCI), cancer, stroke, primary care conditions]. Methods Participants completed the BMMRS as part of a pilot study on spirituality, religion, and physical and mental health. Results A principal components factor analysis with varimax rotation and Kaiser normalization identified a six-factor solution (opposed to the expected 8-factor solution) accounting for 60% of the variance in scores, labeled as: (1) Positive Spiritual Experience; (2) Negative Spiritual Experience; (3) Forgiveness; (4) Religious Practices; (5) Positive Congregational Support; and (6) Negative Congregational Support. Conclusions The results suggest the BMMRS assesses distinct positive and negative aspects of religiousness and spirituality that may be best conceptualized in a psychoneuroimmunological context as measuring: (a) Spiritual Experiences (i.e., emotional experience of feeling connected with a higher power/the universe); (b) Religious Practices (i.e., prayer, rituals, service attendance); (c) Congregational Support; and (d) Forgiveness (i.e., a specific coping strategy that can be conceptualized as religious or non-religious in context).     

Introduction to Multi-Level Community Based Culturally Situated Interventions

This introduction to a special issue of the American Journal of Community Psychiatry is the result of a symposium at the Annual Meeting of the Society for Applied Anthropology, 2006, that brought together anthropologists and psychologists involved in community based collaborative intervention studies to examine critically the assumptions, processes and results of their multilevel interventions in local communities with local partners. The papers were an effort to examine context by offering a theoretical framework for the concept of “level” in intervention science, and advocating for “multi‐level” approaches to social/behavioral change. They presented examples of ways in which interventions targeted social “levels” either simultaneously or sequentially by working together with communities across levels, and drawing on and co‐constructing elements of local culture as components of the intervention. The papers raised a number of important issues, for example: (1) How are levels defined and how should collaborators be chosen; (2) does it matter at which level multilevel interventions begin; (3) do multilevel interventions have a greater effect on desired outcomes than level‐specific interventions; (4) are multilevel interventions more sustainable; (5) are multilevel interventions cost effective to run, and evaluate; (6) how can theories of intervention be generated and adapted to each level of a multilevel intervention; (7) how should intervention activities at each level coordinate to facilitate community resident or target population empowerment? Many of these questions were only partially addressed in the papers presented at that time, and are more fully addressed in the theoretical papers, case studies and approach to evaluation included in this collection.     

Experimental effects of rumination styles on salivary cortisol responses

Emerging research suggests that rumination increases risk for negative health outcomes. In the first experiment to investigate cortisol responses during angry rumination, participants were provoked and induced to engage in self-focused rumination, provocation-focused rumination, or distraction. Consistent with social threat theory, self-focused rumination maintained high levels of cortisol following provocation, whereas provocation-focused rumination and distraction facilitated decreases in cortisol. However, even within the provocation-focused rumination condition, adopting an emotionally reactive, self-immersed perspective was associated with higher levels of cortisol as were thoughts about the self. Individual differences in displaced aggression but not general aggression were also positively associated with cortisol levels in the provocation-focused condition. The present findings shed light on rumination styles and cortisol responses in ways that may have long-term consequences for health and well-being.

Cognitive epidemiology: With emphasis on untangling cognitive ability and socioeconomic status

This commentary touches on practical, public policy, and social science domains informed by cognitive epidemiology while pulling together common themes running through this important special issue. As is made clear in the contributions assembled here, and others (Deary, Whalley, & Starr, 2009; Gottfredson, 2004; Lubinski & Humphreys, 1992, 1997), social scientists and practitioners cannot afford to neglect cognitive ability when modeling epidemiological and health care phenomena. However, given the dominant concern about the confounding of general cognitive ability (GCA) and socioeconomic status (SES), and the extent to which SES is frequently seen as the primary cause of health disparities (while GCA is neglected as a possible influence in epidemiology and health psychology), some methodological applications for untangling the relative influences of GCA and SES are reviewed. In addition, cognitive epidemiology is placed in a broader context: Just as cognitive epidemiology facilitates an understanding of pathology (“at risk” populations, and ways to attenuate undesirable personal and social conditions), it may also enrich our understanding of optimal functioning (“at promise” populations, and ways to identify and nurture the human and social capital needed to develop innovations for saving lives, economies, and perhaps even our planet). Finally, while GCA is likely the most important dimension in the study of individual differences for modeling healthy behaviors and outcomes, other relatively independent dimensions of psychological diversity do add value (Krueger, Caspi, & Moffitt, 2000). For example, compliance has at least two psychological components: a “can do” competency component (ability) and a “will do” motivational component (conscientiousness). Ultimately, developing and modeling healthy behaviors, interpersonal environments, and medical maladies are best accomplished by teaming multiple dimensions of human individuality.     

Does a fitness factor contribute to the association between intelligence and health outcomes? Evidence from medical abnormality counts among 3654 US Veterans

We suggest that an over-arching ‘fitness factor’ (an index of general genetic quality that predicts survival and reproductive success) partially explains the observed associations between health outcomes and intelligence. As a proof of concept, we tested this idea in a sample of 3654 US Vietnam veterans aged 31–49 who completed five cognitive tests (from which we extracted a g factor), a detailed medical examination, and self-reports concerning lifestyle health risks (such as smoking and drinking). As indices of physical health, we aggregated ‘abnormality counts’ of physician-assessed neurological, morphological, and physiological abnormalities in eight categories: cranial nerves, motor nerves, peripheral sensory nerves, reflexes, head, body, skin condition, and urine tests. Since each abnormality was rare, the abnormality counts showed highly skewed, Poisson-like distributions. The correlation matrix amongst these eight abnormality counts formed only a weak positive manifold and thus yielded only a weak common factor. However, Poisson regressions showed that intelligence was a significant positive predictor of six of the eight abnormality counts, even controlling for diverse lifestyle covariates (age, obesity, combat and toxin exposure owing to service in Vietnam, and use of tobacco, alcohol, marijuana, and hard drugs). These results give preliminary support for the notion of a superordinate fitness factor above intelligence and physical health, which could be further investigated with direct genetic assessments of mutation load across individuals.     

Health Status and Peer Relationships in Early Adolescence: The Role of Peer Contact, Self-esteem, and Social Anxiety

We examined associations between children’s health status and the quality of their peer relationships, as well as factors that may account for individual variation in the quality of chronically ill and healthy children’s peer relationships. Our sample included 268 children (138 boys; 130 girls) with 149 European-Americans and 119 African-Americans. There were 91 children with a chronic illness; 35 with asthma, 26 with diabetes, and 30 with obesity. Chronically ill children were characterized by teachers as displaying less prosocial behavior, less overt aggression, and less relational aggression with peers than healthy children. Chronically ill children reported lower levels of peer contact and higher levels of social anxiety than healthy children. Among chronically ill children those with high self-esteem were more prosocial and less aggressive than those with low self-esteem. Our findings suggest that chronically ill children are at risk for peer relationship difficulties, but that self-esteem may serve as a protective factor against poor peer relationships for some chronically ill children.     

Expressions of positive emotion in photographs,personality, and later-life marital and health outcomes

A previous study of females at an elite liberal arts college found that the degree of positive emotion expressed in persons’ college yearbook photos was correlated with personality, marital, and health outcomes decades later in life. We examine whether the same pattern is observed among respondents in the Wisconsin Longitudinal Study, using high school yearbook photographs and outcome measures obtained mostly when respondents were in their fifties. Despite some seeming advantages of our design, we were unable, with a few exceptions, to replicate the findings of the previous study. Possible explanations for this divergence in findings are discussed, including differences in measurement, the sample, and the photographic occasion itself.     

The dilemma of primary prevention in mental health services: Rationalize the status quo or bite the hand that feeds you

That primary prevention has been ‘inappropriately marginalised’ is seen to be an inevitable outcome of reliance on government support. Policy makers and service providers can never be expected to give prevention a higher priority than direct service. Preventionists have developed two strategies for doing their work. One, based on the logical positivist ideal, seeks specific causal models for specific disorders. This sort of prevention research, while it will always remain less well funded than direct services, tends not to challenge the status quo belief in individual responsibility, or the acceptable methods of mainstream science, and thus will tend to be more acceptable than other forms of prevention research and services. An alternative, based on a social constructivist paradigm engages in social action research through collaboration with a variety of grass roots organizations and people outside the mainstream of power. This latter approach, brings to preventionists ideas from feminists, ethnic minority leaders, neighborhood organizers, and self and mutual help group leaders. It is a sensible way to use the resources available to those professionals interested in social change oriented prevention.