社区卫生服务首诊制与医师多点执业

阐述了社区卫生服务首诊制的概念及其对规范医疗卫生次序的重要作用, 深入分析了限制社区卫生服务首诊制发展的主要因素。从正反两个方面分析了医师多点执业对首诊制的影响:医师多点执业能提高社区卫生人力资源的质量, 增强民众对社区卫生机构的信任度;但是医师多点执业也会造成医院和社区卫生机构管理上的问题, 医生自身也需要时间适应自身角色的转变。鼓励大医院办社区卫生服务机构, 增加社区医疗机构的政府补偿, 吸引医师到基层多点执业, 增强社区卫生服务首诊的能力。     

The therapeutic community in the local community: Social networks between therapeutic community and supported housing

In this paper, the authors present a model for therapeutic community programmes for those with severe and enduring mental ill health, based on social networks. These programmes have given birth to a range of therapeutic community which are, in fact, an innovative form of group psychotherapy. These new model do not depend on communal living. Some are groupings of apartments, others day units. Work schemes also feature here. And yet, as the authors outline, various components need to be present if these are to be considered genuine therapeutic communities and not just supported housing schemes. Additionally, a certain kind of training and clinical supervision is needed for the staff.     

Transference and countertransference in an applied setting — education

This paper offers an overview of current clinical approaches to psychoanalytically informed work with parents by child psychotherapists. The analysis is based on practice at the Tavistock Clinic and on broader knowledge of trends in work with children and families within the National Health Service. A brief history sets the scene. Four varieties of approach are described, with clinical examples. The particular sensitivity of child psychotherapists to infantile features in the personality is highlighted, and it is argued that this, together with their broad clinical experience, provides a proper basis for psychoanalytic psychotherapy with parents. Such work significantly extends and enriches the clinical contribution of child psychotherapists and has involved a shift in professional identity. It also raises ethical issues which are discussed.     

Richard Wagner and the Birth of The Birth of Tragedy 1

Abstract

Nietzsche writes that the ‘real task’ of The Birth of Tragedy is to ‘solve the puzzle of Wagner’s relation to Greek tragedy’. The ‘puzzle’, I suggest, is the intermingling in his art and writings of earlier socialist optimism with later Schopenhauerian pessimism. According to the former the function of the ‘rebirth of Greek tragedy’ in the ‘collective artwork’ is to ‘collect’, and so create, community. According to the second the function of the artwork is to intimate a realm ‘beyond’ this world of pain and death. The audacity of The Birth is that it attempts to show that Wagner can have his cake and eat it: the ‘Dionysian’, musical, element provides a ‘metaphysical comfort’, while the ‘Apollonian’, verbal, element draws a ‘veil of oblivion’ over the metaphysical, thereby allowing the artwork to solidify community. Contrary to the standard Anglophone view, this perspective on The Birth shows that Nietzsche’s intimate association with Wagner during the period of its creation lies at the heart of its philosophical content.     

Global megatrends and the community

An examination of the thesis of Asian megatrends as conceived of in the literature until recent times, is reviewed. Major ramifications within it, such as the role of Asian values, economic growth and development, a self‐reliant nationalism different from the West, and the rise of a human development concept, are critically examined. Yet the role of community as substantively defined in this paper, is found to have remained ignored in the study of major megatrends between the West and the East. This remiss in the study of human futures within a politico‐economic developmental context is argued to cause unsustainability of the megatrends paradigm. The projected decline of the Asian megatrends is shown to arise from its absence of an understanding of a ‘globally’ interactive, integrative and evolutionary process of understanding historical change. Within this new paradigm the epistemology of community is shown to play a much more substantive role than simply the pursuit of growth and development in the midst of capitalist globalism. Substantive methodological implications are shown to emanate from such a different view of studying megatrends in general. The concept of objective globalization is thereby derived.     

An introduction to the phenomenology of religion

This article examines how a secular lesbian, gay, bisexual, transgender, queer (LGBTQ) community choir in New Zealand negotiates a relationship with sacred repertoire, and the church in which the choir is located. A mixed-methods study included semi-structured interviews with 26 current and past members, musical directors and a church representative. Themes that emerged included tensions between religion and an LGBTQ cultural secularism, intersections of reconciliation and affirmation and the identity constitutive uses of space. Findings suggest that although, as LGBTQ-identified people, secularism is an important identity, sacred music is pleasurable. The choir provides church-like functions, through a sense of community, ritual and an environment for spiritual reflection and the practice of values. The church location offers reconciliation for those with Christian backgrounds. Benefitting each other, the choir gives St. Andrew’s legitimacy in its identity as an LGBTQ-inclusive church, and the church space has a queering effect on the presentation of the choir.     

Perceived partner support and psychosexual adjustment to breast cancer

Support from a partner can play a key role in a woman's emotional adjustment to breast cancer. However, little is known about the influence of partner behaviours on a woman's sexual adjustment. This study examined the prospective relationship between baseline levels of several types of perceived partner support (instrumental, informational, emotional and negative) and psychosexual adjustment (sexual functioning and relationship satisfaction) over the course of 12 months post-surgery in a sample of 130 women with breast cancer. Results indicated that perceptions of greater emotional and informational support from the partner at baseline were associated with less sexual difficulties among breast cancer patients concurrently and 6 months post-surgery. Baseline perceptions of greater emotional and instrumental support from a partner were associated with greater relationship satisfaction at all time points. Perceptions of informational support at baseline were related to greater concurrent relationship satisfaction. Baseline perceptions of negative partner support were related to less relationship satisfaction, but only concurrently. These findings suggest that the perception of a partner's provision of emotional, instrumental and informational support may each play a role in facilitating sexual adjustment and relationship satisfaction.     

Community‐oriented primary care: a multidisciplinary community‐oriented approach to primary care?

Developing more of a local public health focus, and involving local communities in Great Britain in health care decision‐making, are key aspects of the radically changing face of primary care. Community‐oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ‘Modern and Dependable NHS’, but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd.     

‘Someone to talk to who'll listen’: addressing the psychosocial needs of children and families

The paper presents the Lewisham Community Child and Family Service (LCCFS), a community‐based intervention providing psychosocial help for children, young people, parents and families. The service is focused on early intervention, prevention and promotion in the improvement of local health. It works under a service framework based on inter‐agency collaboration, and a counselling model based on community and interpersonal partnerships, grounded in personal construct theory (Kelly, 1955). The policy demands and local need for accessible and acceptable mental health are discussed, and quantitative and qualitative findings of the needs assessment preceding the establishment of the LCCFS are presented, supporting the need for community mental health provision. The feasibility for the LCCFS to reconcile and meet the policy demands and the needs of parents with respect to child psychosocial help and services are discussed. Copyright © 2001 John Wiley & Sons, Ltd.     

社区老年人心理健康评价模式研究

在已有研究证据和理论框架基础上,本文对社区老年人心理健康状况(PWB)的理论构念及其多指标评价模型进行实证研究。验证性因素分析表明,从正性情感、负性情感摆脱、愿望与实际所得的符合程度以及自尊感四个核心领域对PWB进行综合评价的模型与社区老年人(N=220)测评数据的拟合度良好。研究结果也表明,根据该模型而建立的量表具有符合心理测量学要求的信度和效度,能够对社区老年人的心理健康状况进行有效评价,并可用于老年心理疾患的筛查。