A consumer-constructed scale to measure empowerment among users of mental health services

OBJECTIVE: A scale to measure the personal construct of empowerment as defined by consumers of mental health services was developed and field tested. METHODS: After extensive development, pilot testing, and analyses, a 28-item scale to measure empowerment was tested on 271 members of six self-help programs in six states. Factor analyses were used to identify the underlying dimensions of empowerment. To establish the scale's reliability and validity, responses were factor analyzed, and other analyses were conducted. RESULTS: Analyses revealed five factors: self-efficacy-self-esteem, power-powerlessness, community activism, righteous anger, and optimism-control over the future. Empowerment was related to quality of life and income but not to the demographic variables of age, gender, ethnicity, marital status, education level, or employment status. Empowerment was inversely related to use of traditional mental health services and positively related to community activism. CONCLUSIONS: The findings set a framework for a clearer understanding of the imprecise and overused concept of empowerment. The scale demonstrated adequate internal consistency and some evidence for validity. Further testing must be done to establish whether it has discriminant validity and is sensitive to change.     

Beneficiary choice and interprofessional participation in CHAMPUS mental health services: 1980–1987.

As a major health plan with freedom of choice of provider, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) yields natural experiments in fee-for-service practice that are relevant to mental health policy. This is seen in the extent to which (1) beneficiaries use multiple mental health providers or a single (exclusive) provider, (2) psychiatrists have been replaced as the major provider, (3) general physicians are increasingly involved, and (4) psychologists have penetrated this market over the years 1980–1987, including some inpatient practice and the emergence of a general physician/psychologist alliance. The cost and public policy aspects are discussed against an empirical background. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of sexual health services within Australia and New Zealand

The life expectancy of patients with malignant disease has significantly lengthened with improvements in surgical and adjuvant therapy. A multidisciplinary team approach to these patients is essential. The use of modern fixation techniques or endoprosthetic replacement, with or without cement augmentation can significantly improve the quality of life of patients with metastatic disease, either presenting with pathological fracture or with impending fracture.     

Legal, professional, and financial constraints on psychologists' delivery of health care services in school settings.

Psychologists' participation in the delivery of health care (HC) services in schools will be determined in part by legal, professional, and financial constraints. Legal parameters include both current and proposed federal and state legislation related to education and HC as well as licensing and credentialing issues and legal and ethical complications arising from service integration across disciplines. Recognition of psychologists as HC providers in schools is also likely to be affected by credentials and standards for practice issued by various government agencies or professional associations and by the funding mechanisms established to support a reformed American HC system. The purpose of this article is to stimulate exploration of solutions for the obstacles and innovative responses to the opportunities presented for psychologists' participation in the delivery of HC services in schools. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The consequences of universalizing health services: children's use of health services in Catalonia

The purpose of this study was to assess the role of needs and social factors in the use of health services among children under age 15 in Catalonia, Spain, where health care reform was explicitly designed to facilitate universal access to primary care according to health needs. Data from the Catalan Health Interview Survey of 1994, a multistage probability sample (2,433 children under 15 years old), were analyzed. Multiple regression examined the relationship between health needs and number of visits in the last year, controlling for the effect of sociodemographic characteristics. Two logistic regression equations were selected to predict heavy (more than seven visits per year) and light (less than two visits) utilization of services. The multiple regression model explained 14.3 percent of the variance in number of visits, with health status perception, disability, reported chronic condition, restriction of activities, and having had a recent accident by far the most important determinants. No familial socioeconomic characteristics, including social class, education, or family size, influenced the extent of use. In contrast to health systems not designed to achieve either universal access according to need or strong primary care, universal access to health services in Catalonia appears to enhance the use of services among children with health needs, regardless of socioeconomic characteristics.     

Grass roots participation in health care reform

Concerned citizens have responded to the health care crisis by developing the health decisions movement. American Health Decisions, a national consortium of 21 state organizations, leads a grass roots discussion network of community meetings committed to education and consensus on the ethical, technologic, legal, and economic issues (the tough issues) of health policy. The movement (with its stages of development, structure, process, and accomplishments) is described, and potential roles for physician cooperation and participation in forging functional, community-based health policy are delineated.     

Provision of mental health services in women's health centers

Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of comprehensive care was implemented with respect to mental health services. Specifically, we examined the rates of screening and treatment for a subset of mental health and behavioral and social problems in women's health centers and the structural, staffing, philosophical, and patient factors associated with the provision of services. Across 12 services, the overall rates of provision ranged from 7.7% for screening for dementing disorders to 27.6% for smoking cessation counseling and treatment. In a series of logistic regressions, center type (primary care) and having a mental health staff person were consistently associated with service provision; other important variables were having a high percentage of women using the center as their usual source of care and having a belief in women-centered care. Findings indicate that the majority of women using women's health centers do not receive services in a comprehensive care environment that includes key mental health services.     

Delivery of mental health services in the changing health care system.

Comments on the anonymous article, "Hidden benefits of managed care" (see record 1995-33982-001), in which the author expresses concern that managed care organizations are making decisions on the basis of economics and not the well-being of the patient. B. Miller and L. Farber empathize with the author's concerns, but contend that, if structured properly, HMOs can become the vehicle for the reengineering of mental health services that will produce the best patient outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A review of studies of heavy users of psychiatric services

OBJECTIVES: This paper reviews studies of patients who are heavy users of psychiatric services and identifies areas in which further research and evaluation are indicated. METHODS: Extensive searches were conducted of the English language psychiatric and psychological literature before 1994. Important references from initially identified studies were followed up. More than 200 articles were reviewed, 72 of which are described in this review. The 72 papers were selected because they dealt with three questions: What is heavy service use? What patient characteristics contribute to it? What service delivery characteristics contribute to it? RESULTS AND CONCLUSIONS: Criteria for identifying and defining heavy users of psychiatric services vary among studies. Few studies of heavy service users have attempted to examine use of all psychiatric services, both inpatient and community based. In most studies, 10 to 30 percent of patients are identified as heavy users, those who utilize between 50 and 80 percent of service resources. This group consists of a constantly changing cohort of patients who generally have psychotic illnesses as well as comorbid personality disorders and high levels of drug and alcohol misuse. Few studies have examined social issues such as isolation, homelessness, and social support, although these factors appear to contribute significantly to heavy service use. Few attempts have been made to define heavy-user groups in fiscal terms. More research on heavy users of psychiatric services is clearly needed to improve providers' ability to plan appropriately targeted mental health services for this disabled group of patients who use expensive resources.     

Volunteerism and the reorientation of health services

Volunteers are increasingly viewed as health agents. This seems to be linked to the reorientation towards primary health care and the current reforms in the health services. Seen as a way of breaking down social and cultural barriers between the formal health care system and the client community it also claims to cut the cost of services. OBJECTIVE: To know the roles of volunteers in promoting health and the practical aspects of implementation and evaluation. DESIGN: This paper is based on a review of published and sentinel papers from the bibliographic databases, MEDLINE (1991-1995), ERIC (1982-1995) and ERIC INTERNATIONAL (1965-1995). We have also reviewed the IME (until 1997) and the Spanish journals in MEDLINE to know the Spanish context (from 1995-98). RESULTS: The practical experiences from developing countries, the USA and the UK were reviewed within the framework of health promotion. A wide variety of experiences exist. There is a striking difference between activities in these countries, depending of the health service provision. In developing countries the aim is to bring primary health care services to areas with few professional resources. In developed countries, however, experiences have developed in response to failings in the formal health care system, to facilitate illness prevention and health promotion. The settings are different but the process is the same, factors fundamental to performance have therefore been identified in: recruitment, training, monitoring, continuing support and evaluation. The impact on health improvements and the quality of services in both systems, developed and developing countries, seems to be positive. We haven't found too much details from the Spanish experience, then, it emphasizes the need to know abroad experiences. CONCLUSIONS: Finally, the benefits and constraints derived from this type of voluntary action in the health field have been raised. Some specific social changes and health care system reforms contribute to establish volunteering in the health system, but we have to remark organization, coordination and community participation.     

Estimating the impact of health services in a community

The advantages of clinical and mechanical combination of observations for prediction are mutually reinforced by an application of Bayesian statistics. The technique is shown to be particularly advantageous in a situation which is characterized by a paucity of observations available to suppliment a prior expert judgment. The approach also presents a basis for evaluating relative expertise and tracing the learning experience of experts. Taking the community as the organizational level of analysis, data on the classification of aged persons in Durham County, North Carolina, and data on the changes in classification of these individuals within the population over time are gathered and studied. These data are combined with clinical judgments of changes as a demonstration of the merits of the technique developed in this paper.     

Reported health status among farmers and nonfarmers in nine rural districts

Farmers appear to have a lower morbidity and mortality rate than other occupational groups. Whether this better health is due to exposure to farming or to the well-known fact that rural populations have better health than urban ones, irrespective of occupation, is not clear. To explore this problem, all male farmers in nine administrative areas and age-matched nonfarmers from the same rural areas were sampled and invited to participate in a survey. 1782 (76%) men responded. We found that farmers had somewhat lower rates of outpatient health care utilization for causes other than trauma and fewer hospital admissions. These differences were independent of the urban-rural factor and could not be explained by traditional determinants of health and health care utilization. Other factors, linked to farming or to farmers' lifestyles, are probably involved.     

Latex allergy in health services workers

The studies were performed in 20 workers from the Health Service (13 women and 7 men in the age 25-57) suffering from hand urticaria (6 persons) and hand dermatitis (14 persons) suspected of the allergy to latex gloves. In all patients the familial and personal predispositions to allergy were evaluated by the anamnesis, the estimation of total IgE serum level and the skin prick tests (SPT) with inhalant allergens. The latex allergy was diagnosed by SPT and contact test with standardized extract of the natural latex allergen in the concentration 1000 PNU/ml (Nexter-Allergopharma) and by estimation of specific to latex IgE serum level. In addition to this, contact tests with glove's material as well European standard contact allergens (Hermal) were done and the one with antiseptic substances to which the patient was exposed at his work. The allergy type I to latex gloves was confirmed in all 6 cases with contact urticaria. The SPT with standard extract of the natural latex was more valuable than latex specific IgE in the serum. Contact allergy (type IV) to latex gloves was confirmed in 10 from 14 suspected cases. In the next 4 the allergy to antiseptic substances was the reasons of the illness. The allergy to latex gloves appears more often in women. No case showed the familial predisposition to allergy and only 4 patients additionally suffered from the allergy to pollen and mites. Moreover in both groups of patients we showed the presence of the additional contact allergy to different allergens (to metals and antiseptic substances).     

Finnish health centre physicians'' participation in family planning

A patient who was given tamoxifen as adjuvant treatment for breast cancer developed very severe hypertriglyceridaemia, hypercholesterolaemia and acute pancreatitis after being treated for 4 months. The hyperlipidaemia was corrected after cessation of the tamoxifen and the institution of gemfibrozil treatment. This patient appears to have type IV hyperlipidaemia. It is suggested that, in such patients, tamoxifen should be used with extreme caution because the weakly oestrogenic effect of this agent can cause severe and life threatening hyperlipidaemia.