Borderline personality disorder in an intermediate psychological therapies service

The intermediate psychological therapies service is provided for individuals referred with common mental health problems within the primary care psychological therapies service, but whose difficulties are longstanding and/or complex. The prevalence of borderline personality disorder (BPD) in intermediate psychological therapy services has not been researched to-date. The current study aimed to measure the prevalence of BPD amongst patients attending intermediate psychological therapies (n?=?63). The prevalence of BPD was established by identifying the number of patients who met DSM-IV criteria. BPD prevalence amongst patients attending an intermediate psychological therapy service was 37%. The high proportion of patients presenting with BPD indicates the potential need for staff training and supervision in how to manage such high levels of need at this service level. This is the first study to report prevalence rates of BPD specifically in an intermediate care psychological therapy service.     

美国医疗系统的中流砥柱:非营利性私立医院

系统介绍了美国医疗系统的主流--非营利性私立医院的起源、性质、运行情况以及在医疗服务中的地位,并将之与营利性医院进行对比,以揭示限制医疗市场化的重要意义.     

Measuring social influence of a senior midwife on decision‐making in maternity care: an experimental study

The document Changing Childbirth produced by the Department of Health (1993) requests provision of more choice, continuity and control for women during pregnancy and childbirth. In this context this study considers whether midwives'decisions are influenced by a senior midwife. A simple, valid and reliable scale—the Social Influence Scale for Midwifery (SIS‐M)—was devised to measure and score midwives' private anonymous responses to 10 clinical decisions. The SIS‐M was initially administered as a self‐completed postal survey by 209 midwives. Following a 9‐month time gap, a stratified sample of 60 (20 E, F, G grade midwives) were invited for interview in which a senior midwife attempted to influence SIS‐M responses in a conformist direction. Overall, a 3 × 2 (E, F, G grade midwives x private and interview SIS‐M scores) analysis of variance (ANOVA) revealed midwives were significantly more conformist when influenced by a senior midwife, in comparison to private anonymous responses. No significant interaction between groups was found. These findings indicate that there is influence of a senior midwife on clinical decisions that should be woman‐centred, according to Changing Childbirth (1993). The implication is that this influence may remove choice from women. Copyright © 2005 John Wiley & Sons, Ltd.     

Dementia care‐giving in black and Asian populations: reviewing and refining the research agenda

Despite the increased prevalence of dementia little work has been done to explore the extent and nature of care‐giving in black or Asian‐UK populations. Evidence that does exist suggests that the consequences of care‐giving are significant but different from those experienced by white carers and are mediated by a number of culture‐related factors. These include: ethnically specific conceptualisations of dementia; expectations of family duty; religiosity; the adoption of positive re‐appraisal strategies, and beneficial outcomes. Present approaches to research are narrow, do not take account of cultural dimensions and employ terminology and care‐giving frameworks which are of limited relevance. That the evidence base is characterised by small‐scale studies, and weak methodology further undermines its validity. Research deficits are systemic and fundamental and are both conceptual and methodological. A key contribution would be the development of a multi‐dimensional theoretical model that takes account of the role played by culture, ethnicity and structural inequality in shaping care‐giving experiences and profiles. Incorporating the perspectives of black and Asian carers, and the influence of the life course of individuals and communities and employing qualitative methods would also influence the direction of research, improve its quality and generate knowledge in this underdeveloped field. Copyright © 2005 John Wiley & Sons, Ltd.     

开放医疗市场 强化政府责任 解决看病难

当前对医疗改革的批评较多,不少人认为是过度市场化的结果。但是,“过度市场化”的问题不能一概而论,可以从两个方面来分析,从医疗服务方面来说,有过度市场化的倾向;但是从医疗资源的配置或投入来说,市场又没有充分放开。所以不能简单的或笼统的把医改的问题归咎于市场化。该开放的医疗市场未开放,政府责任不到位,才是当前中国医疗改革的问题所在。     

Widows, women, and the bioethics of care.

Widows, women, and the bioethics of care must be understood within an authentic Christian ontology of gender. Men are men and women are women, and their being is ontologically marked in difference. There is an ontology of gender with important implications for the role of women in the family and the Church. The Christian Church has traditionally recognized a role for widows, deaconesses, and female monastics, which is not that of the liturgical priesthood, but one with a special relationship to care and therefore with particular implications for health care and a Christian bioethics of care in the twenty-first century. In the shadow of early male mortality, women as wives should turn to support their husbands and as widows to support those in need. Widows, in becoming authentic Christian monastics, can bring into the world an icon of rightly ordered women providing rightly ordered Christian care for those in need. They can enter the moral vacuum created by misunderstandings of the place of women and the service vacuum created by a disappearance of religious nuns in Western health care facilities with a presence that is at one with the Church of the Fathers.     

对不同所有制卫生服务提供者评价的国际导向

不同所有制并存是世界范围内卫生系统共有的特征.随着不同所有制在卫生系统中份额的增加,尤其是私立卫生服务提供者的引入,如何对他们提供的服务和产生的影响进行评价,越来越引起研究者的关注.阐述了对不同所有制提供者进行评价的背景,呈现了目前对私立卫生服务提供者评价的不同观点,并介绍了国际实证研究的结果.     

终末期癌症病人诊治中的心理特征与人文关怀

在诊治终末期癌症病人过程中不仅要关心他们的躯体方面,更要关心他们的心理方面,在诊治过程中要根据他们的独特的心理特征来进行人文心理关怀,维持生命质量和保证他们应有的人格尊严.     

A Standard of Care for the Assessment of Suicide Risk and Associated Treatment: The Florida State University Psychology Clinic as an Example

The Florida State University has established a set of guidelines to be used as a standard of care for suicide. This standard of care guides therapists through a suicide risk assessment that focuses on key variables related to suicidal behavior that are among the best predictors of completed suicide. This standard of care includes necessary components of suicide risk assessment, critical steps to follow to ensure the safety of suicidal patients, treatment recommendations, and guidelines for minimizing the legal risk of the therapist. Though this standard of care was developed in a research and training clinic, these principles may be applied to all clinicians offering psychological services to patients, regardless of the nature of the clinic or setting.     

Social disadvantage and neglectful parenting as precursors to the development of antisocial and aggressive child behavior: Testing a theoretical model

The present study tested a theoretical model advanced to understand the direct and mediated effects of social disadvantage, neglectful parenting, and punitive parenting in the developmental trajectory of aggressive and antisocial behavior in young school‐aged children. To test the model, families of 310 first grade children and 361 fifth grade children, participating in a universal prevention trial in high‐risk areas of a medium‐sized metropolitan area, provided data. Multi‐method and multi‐source indices of the four predictive constructs (Social Disadvantage, Denial of Care Neglect, Supervisory Neglect, and Punitive Discipline) were obtained at the time of enrollment. Multi‐method and multi‐source indices of the criterion construct (Aggression and Antisocial Behavior) were obtained at the time of enrollment and at a five year follow‐up. Based on structural equation modeling, the results established care neglect as a mediator of social disadvantage, and the importance of care neglect to both punitive discipline and antisocial outcomes in the first‐ and fifth‐grade cohorts. Supervisory neglect, however, was important in the antisocial outcome of the fifth‐grade cohort only. Overall, the results established the importance of distinguishing between two subtypes of neglect and the need to consider the role of discipline in concert with neglect when attempting to understand the impact of parenting on the development of antisocial behavior. Aggr. Behav. 30:187‐205, 2004. © 2004 Wiley‐Liss, Inc.