我国特需医疗服务发展基本思路探讨

针对我国特需医疗服务实施现状中存在的弊端,在重新界定特需医疗服务内涵的基础上,提出将医疗服务从所提供服务的普遍性角度划分为特需医疗服务与普通医疗服务,改变所有公立医院均可提供特需医疗服务的现状,只允许私立医院和一部分自负盈亏的企业型公立医院提供特需医疗服务的发展思路。     

Lack of early child care effects on school-age children's social competence and academic achievement

Teacher ratings of social competence and academic achievement were obtained from a sample of 127 Bermudian children at ages 5, 6, 7 and 8 years. The children were studied first during their pre-school years, when they had been exposed to various amounts and qualities of day care. Quality of care was found to be important to the children's intellectual and social development while they were in the day care settings but not after 1–4 years of primary schooling. In hierarchical and simultaneous regressions, family background characteristics, not child care amounts or qualities, were found to be predictive of social competence and academic achievement in the primary grades. By school age, the effects of infant and preschool child care experiences were no longer influential in children's development, but family background continued to be important. These findings and their implications for child care are discussed.     

Does personality moderate the link between women’s testosterone and relationship status? The role of extraversion and sensation seeking

Research shows that testosterone (T) is lower among partnered women, but not for women with a more unrestricted sociosexuality. There are fundamental personality traits, which are indices of mating effort and might moderate the association between T and relationship status. Two such traits are extraversion (E) and sensation seeking (SS). The present study tests if E and SS moderate the association of women’s T with relationship status and parental care. Seventy-three Portuguese women completed a short form of the NEO-FFI and the Sensation Seeking Scale (SSS-V). Salivary T was assayed using luminescence immunoassays. Being involved in a committed relationship was related to lower T for the total sample, and for the subgroups low in E and SS, but not for the subgroups high in E and SS. Parental care was related to lower T in the subgroup low in E, and marginally in the subgroup low in SS. In multivariate analyses, only relationship status predicted T in the total sample and in the subgroups low in E and SS. The results were not confounded by age and oral contraception. These results provide support for lower T being important for monogamous pair bonding rather than for being partnered per se.     

Foster Care Chronicles: Use of the Arts for Teens Aging Out of the Foster Care System

This article describes the use of narrative and drama therapies as creative therapeutic interventions to engage and assist vulnerable youth. Foster Care Chronicles was a collaboration between a state university social work program and a local department of social services in a child welfare unit. This 2-year exploratory project employed an innovative approach to work with foster care youth, all of whom were within 2 years of “aging out” of care. The project utilized narrative therapy and drama therapy in a group setting by building on youths’ individual and collective strengths in writing, speaking, and acting. As these youth assessed their participation in this program, their reflections addressed developing aspects of self-image, self-healing, self-efficacy, and lessons learned.     

Evidence for an Evolutionary Cheater Strategy—Relationships Between Primary and Secondary Psychopathy,Parenting, and Shame and Guilt

In the present study, shame and guilt proneness were investigated in relation to primary and secondary psychopathy, looking at parental care as a possible mediator. A sample of 388 volunteers participated in an on-line study, completing several self-report measurements. Primary psychopathy, robust to parental care and sex of the participant, was associated with lower guilt proneness after a private transgression and lower negative self-evaluations after a public transgression. Secondary psychopathy was not associated with guilt or shame proneness. Paternal care played a mediating role between primary psychopathy and guilt, but only in male participants. High paternal care was associated with lower guilt repair in high psychopathy males, suggesting that a positive father-son relationship might be essential for development of exploitive strategies in primary psychopathy. The results highlight the fundamental differences between primary and secondary psychopathy, and provide support for the idea that primary psychopathy is an evolutionary cheater-strategy.     

Factors affecting behavioral health provider turnover in US Air Force primary care behavioral health services

Turnover and retention of integrated behavioral health practitioners in primary care is a significant challenge with limited empirical evidence to inform risk factors. This study used retrospective archival data from the Air Force Medical Service’s Behavioral Health Optimization Program on all civilian contractors hired from September 2012 to November 2014 to examine the potential influence of training background (e.g., social work v. psychology), size of healthcare facility, or the presence of on-site mentors. Turnover was evaluated across a large managed healthcare organization of 121 civilian contractors (psychologists and social workers) in 72 specific clinic settings. These sites varied considerably in regards to geographic location, population diversity, size of patient empanelment, rural, suburban, and urban settings and all provided care to active duty military, their civilian dependents and civilian retirees. Results found that 54% of all psychologists and social workers hired for these positions quit or were fired within 8 months of employment. Smaller medical facilities were found to have a more significant attrition rate compared to medium- and large-sized facilities; no other differences were noted. Findings provide initial insight into a potential critical period in the first year of a behavioral health consultants on-boarding, as well as unique considerations for consultants placed in smaller facilities who may be at elevated risk for attrition. These preliminary findings suggest targeted interventions for new integrated care programs as well as important avenues for future research.     

Trauma‐Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma‐informed. While community mental health and other human services settings are moving toward trauma‐informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle‐driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second‐order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.     

“Do More,Feel Better”: Pilot RCT of Lay-Delivered Behavioral Activation for Depressed Senior Center Clients

This pilot randomized control trial (RCT) tested “Do More, Feel Better” (DMFB), a lay-delivered Behavioral Activation intervention for depressed senior center clients. The study examined: (1) the feasibility of training older lay volunteers to fidelity; and (2) the acceptability, safety, and impact of the intervention. Twenty-one lay volunteers at four senior centers were trained in DMFB. Fifty-six depressed clients were randomized to receive 9 sessions of DMFB or Behavioral Activation delivered by social workers (MSW BA). Research assessments of overall client activity level (BADS) and depression severity (HAM-D) were conducted at baseline and Weeks 3, 6, and 9. Eighty-one percent of lay volunteers who underwent training were formally certified in DMFB. Depressed clients receiving each intervention reported high levels of satisfaction and showed large and clinically significant changes in 9-week activity level (d ≥ 1.35) and depression severity (d ≥ 3.34). Differences between treatment groups were very small for both activity level (d_MSW = 0.16; 95% CI, -0.70 to 1.02) and depression (d_MSW = 0.14; 95% CI, -0.63 to 0.91). Increases in activity level were associated with decreases in depression (β = -0.42; 95% CI, -0.55 to -0.30). Both interventions appeared to work as intended by increasing activity level and reducing depression severity. “Do More, Feel Better” shows the potential of evidence-based behavioral interventions delivered by supervised lay volunteers, and can help address the insufficient workforce available to meet the mental health needs of community-dwelling older adults.     

Brexit et protection sociale : quel accès aux soins ?

Brexit, by its magnitude, has many legal consequences, including the issue of access to healthcare. Although an exit agreement has been reached between the European Union and the United Kingdom, problems still arise regarding the social protection of European and British residents.