Health Literacy,Health Inequality and a Just Healthcare System

Limited health literacy is a pervasive and independent risk factor for poor health outcomes. Despite decades of reports exhibiting that the healthcare system is overly complex, unneeded complexity remains commonplace and endangers the lives of patients, especially those with limited health literacy. In this article, we define health literacy and describe the empirical evidence associating health literacy and poor health outcomes. We recast the issue of poor health literacy from within the ethical perspective of the least well-off and argue that poor health outcomes deriving from limited health literacy ought to be understood as a fundamental injustice of the healthcare system. We offer three proposals that attempt to rectify this injustice, including: universal precautions that presume limited health literacy for all healthcare users; expanded use of technology supported communication; and clinical incentives that account for limited health literacy.     

贪婪:态度、动机与决策机制

贪婪是人性的重要特点之一,也是哲学、经济学等领域经常讨论的话题.本文首先梳理了贪婪的概念,并将问题聚焦在对于物质的贪婪上.然后总结了贪婪的特点,并提出贪婪的定义.接着阐述了情境因素如何影响个体对贪婪的态度,以及贪婪动机如何影响自利行为.贪婪决策是个体决定是否做出贪婪行为的心理过程,受到自我意识和情绪的影响.贪婪决策过程模型整合了控制性、自动化两类加工方式,阐释了自利倾向与道德自觉相互作用的机制.本文对以上内容逐次进行讨论,并提出了未来研究的方向.     

幸福的体验效用与非理性决策行为的偏差机制

基于体验效用的幸福包括预期幸福、即时幸福和回忆幸福,这三者有极其重要的本质差异,导致决策偏差和非理性。本研究运用行为科学和认知神经科学相结合的研究方法,首次从行为层次—信息加工层次—脑神经层次三个层面,立体地开展幸福感的体验效用与非理性决策行为研究。研究计划分为三个部分:(1)预期幸福、即时幸福和回忆幸福的本质特点和行为规律;(2)三种体验效用产生偏差的认知心理机制;(3)体验效用与非理性决策偏差的脑神经机制。通过系列研究,拟解决三个关键问题:(1)在人类判断与决策过程中,预期、即时和回忆三种效用是如何影响人们的判断与决策?(2)三种体验效用出现偏差的信息加工特点和脑神经机制究竟是什么?(3)三种效用的偏差规律及对政府公共政策的启示。对这些问题的深入探讨,不仅对决策理论研究的发展是一个贡献;对政府管理制定有效的公共政策,避免"牺牲体验追求指标",解决"幸福悖论",同样有很强的实践指导意义。     

Roles of Leisure in Coping with Stress Among University Students: A Repeated-Assessment Field Study

This article reports findings of a study to examine the effects of leisure coping on various stress coping outcomes including: immediate outcomes (perceived coping effectiveness, perceived satisfaction with coping outcomes, and perceived stress reduction) and distal or long-term outcomes (physical and mental ill-health and psychological well-being), above and beyond the contributions of general coping - coping not directly associated with leisure. A repeated-assessment field design was used to examine ways in which university students cope with stressors in their daily lives. The study found that leisure coping beliefs (leisure-generated dispositional coping resources) significantly predicted lower levels of mental and physical ill-health and greater levels of psychological well-being above and beyond the effects of general coping. Also, the use of leisure coping strategies (situation-specific stress coping strategies through leisure) was significantly associated with higher levels of perceived coping effectiveness and stress reduction when the effects of general coping were taken into account. Significant contributions of specific leisure coping dimensions were found as well.     

Innovative Approaches to Child Custody and Domestic Violence in New Zealand

Summary

In 1995, as part of a major review of domestic violence law, the New Zealand Parliament amended the legislation under which disputes about custody of and access to children are determined by the Court. Specifically, the amendment introduced a rebuttable presumption that a parent who had used violence against a child or against the other parent would not have custody of, or unsupervised access to the child unless the Court could be satisfied that the child would be safe during visitation arrangements. Three years after the implementation of this legislation, it is timely to reflect on the impact of this major domestic violence law reform initiative. Our findings indicate that there are indeed advances. Psychological violence is now clearly being considered when Courts are assessing the issue of children's safety. As well, the delineation of mandatory risk assessment factors has led many judges to see a continuum of power and control tactics as relevant in domestic violence related visitation proceedings; the previous emphasis on physical violence has given way to an analysis which more closely reflects accords with women's and children's realities of the abuse they are exposed to. Some of the old problems continue to exist despite the law changes. There are still recent cases where perpetrators of serious violence are awarded unsupervised access and where their violence continues to be construed as “out of character,” arising because of the perpetrator's “despair” about the breakdown of his relationship. These and other issues are discussed.     

Les interventions préventives en santé mentale du jeune enfant vues par leurs bénéficiaires : l’exemple du projet CAPEDP

ObjectiveHome-visiting programs have become one of the most popular early childhood interventions, though their impact on parents and children remain uncertain. Outcomes measures often rely on experimental quantitative design and little space is offered for the voices of those served by these interventions. This paper presents the results of a qualitative protocol performed by the research team with participants in the CAPEDP project which took place in France from 2005 to 2011.MethodAll 184 women who had accepted at least one home visit in the CAPEDP programme were contacted and invited to participate. Individual and group interviews were conducted with the first 16 who accepted to participate. The semi-structured interview schedule addressed their overall appreciation of the project, their initial concerns, the quality of their relationship with their home visiting psychologist, positive and negative aspects of the intervention and any recommendations they might have for future interventions. Interviews were recorded, transcribed and anonymised. An inductive categorical thematic analysis was performed by the research team.ResultsParticipants expressed overall satisfaction with the CAPEDP intervention, underlining the quality of the relationships with the home visitors, usefulness of parental guidance, the fact that the intervention could be adapted to suit their own personal agenda, routine and needs, the importance of learning how to accept help and give help to others. Less positive aspects included the fact that the home visitors were not mothers themselves and that they lacked technical experience, the difficulty ending the relationship at the end of the 27-month project, insufficient integration of fathers, the difficult and time-consuming evaluation protocol and the lack of interaction with other parents during the intervention.ConclusionAlthough mothers who accepted to participate in the qualitative interview schedule may have had a more positive overall experience of the CAPEDP project than those who declined to participate, participants’ points of view provide potentially useful indications for adapting future home-visiting programs to the French context.     

Demands,resources, and work ability: A cross-national examination of health care workers

Understanding work ability, with the goal of promoting it, is important for individuals as well as organizations. It is especially important to study work ability in health care workers, who face many work-related challenges that may threaten work ability. We studied various job demands, job resources, and interactions of demands and resources relating to work ability using the Job Demands–Resources model as a framework. Acute care health care workers from six nations (US, Australia, UK, Brazil, Croatia, and Poland) completed a survey. Role demands related to work ability in the Australia sample only, and supervisor support related to work ability in the Australia sample only. Yet, high levels of supervisor support significantly moderated (buffered) negative relationships between physical demands and work ability in the US sample, along with negative relationships between role demands and work ability in both the Croatia and UK samples. Skill discretion related to work ability in every nation sample, and therefore appears to be particularly important to work ability perceptions. In addition, skill discretion moderated (buffered) a negative relationship between role demands and work ability in the Australia sample. We therefore recommend that interventions to help preserve or improve work ability target this important job resource.     

Adult age differences in subjective and objective measures of strategy use on a sequentially cued prediction task

Differences in strategy use are thought to underlie age-related performance deficits on many learning and decision-making tasks. Recently, age-related differences in learning to make predictions were reported on the Triplets Prediction Task (TPT). Notably, deficits appeared early in training and continued with experience. To assess if age differences were due to early strategy use, neural networks were used to objectively assess the strategies implemented by participants during Session 1. Then, the relationship between these strategies and performance was examined. Results revealed that older adults were more likely to implement a disadvantageous strategy early in learning, and this led to poorer task performance. Importantly, the relationship between age and task performance was partially mediated by early strategy use, suggesting that early strategy selection played a role in the lower quality of predictions in older adults.     

Health numeracy and cognitive decline in advanced age

ABSTRACT

The study aimed at investigating health numeracy in cognitively well performing healthy participants aged from 50 to 95 years as well as in participants with cognitive impairment, but no dementia (CIND). In cognitively well performing participants (n = 401), demographic variables and cognitive abilities (executive functions, reading comprehension, mental calculation, vocabulary) were associated with health numeracy. Older age, lower education, female gender as well as lower cognitive functions predicted low health numeracy. The effect of older age was partly mediated by executive functions and calculation abilities. Participants with CIND (n = 51) performed significantly lower than healthy controls in health numeracy. The findings suggest that cognitively well performing old individuals have difficulties in understanding health-related numerical information. The risk of misunderstanding health-related numerical information is increased in persons with CIND. As these population groups are frequently involved in health care decisions, particular attention has to be paid to providing numerical information in comprehensible form.