Role of the public health (and environmental) office in urban development--current status and perspectives

Our central question is how the local public health services can influence urban development and urban renewal policies. The need for a three-way cooperation between departments of urban planning and development, environmental affairs and health is now being widely acknowledged. In practice, however, it has to face manifold and serious problems. We suggest that there are basically three essential "instruments" which could lead to a new and defined role of health departments in urban development: environmental and health audits, local health profiles and "health promotion committees" or similar bodies for closer cooperation at the local level. These three "instruments" are described in terms of the present state of development and dissemination by analysing empirical studies from public health research. The results indicate that the "new role" of local health services in urban planning and development is presently fulfilled only in a few pilot cases. The lack of basic requirements particularly in terms of resources, motivation and qualifications is the main cause for the inability to implement the three "instruments" on a broader level in local health services.     

Health care megatrends and health psychology.

Reviews the literature for historical, educational, and health care delivery system contributors to the field of health psychology, which is a major new area of professional practice that has emerged during a period of rapid changes in the health care industry. Four megatrends in medicine and health care are discussed that impinge upon health psychology: the "demythologization" of medicine, changing patterns of medical practice, "remedicalization" of psychiatrists, and alterations in financing health care. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community dentistry: rationale

The present curricula in dentistry are biased in favor of cure and technical capability ... individualism rather than promotive, preventive and community orientation. The team "approach" and "total patient care" concepts must be given emphasis in these curricula. Dentistry, being a profession, should accentuate service, rather than materialism and profit. The Philippine situation demands than adoption of a "New Horizon in Health" which emphasized positive health as part of human development. The educational system, organized dentistry, the licensing board, the legislators, policy makers, oral health providers and research formulators will have important roles to perform in the successful implementation of this "new horizon in health" concept. "Primary Health Care" is another strategy adopted to realize the global goal of "Health for all by Year 2000". This is a positive approach for both individual and community oral health intervention programs.     

Radio-sensitive murine thymoma cell line 3SB: characterization of its apoptosis-resistant variants induced by repeated X-irradiation

This paper describes public health nurses' perceptions of changes in their practice. The participants were 28 public health staff nurses from six Alberta, Canada health units serving urban and rural populations. Data were collected in 1993-94 using individual and focus group interviews. Content analysis was used to identify the following themes: "pulling back", "from hands on to arms length", "handing over responsibility", "developing working partnerships", and "doing less surveillance". These themes are discussed in terms of their implications for population health and for public heath nursing, using as a point of reference the principles of Primary Health Care. Continuing research is needed to chronicle further changes in public health nursing practice that will result from health care restructuring and health system reform.     

A preventive health paradigm for health care psychologists.

Developed a preventive health paradigm for health care psychologists by building on public health and preventive mental health models of primary, secondary, and tertiary prevention. Adoption of a "biopsychosocial" perspective on health and illness is basic to the preventive health paradigm. Examples of preventive health programs are considered along with a wide range of preventive health activities by psychologists in health care settings. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health sciences as an interdisciplinary challenge: the development of a new scientific field

Health sciences in Central Europe have been established in recent years as the academic complement to public health. Unlike the situation outside Europe the link between academia, administration and practical application has become a distinct characteristic of this European philosophy. In this article the two questions are posed: 1. as to which structural problems characterize research into health and illness today and 2. how far can the establishment of an interdisciplinary sphere of "health sciences" provide adequate solutions? The authors also sketch the outlines of the new health sciences as an intergrating and "trans-paradigmatical" teaching and research field and they consider the relationships of health sciences to practice in general, and their relevance to the health services in particular. The challenges in the future for public health and therefore for the health sciences will be enormous. A breakthrough in this field will probably not be achieved until the research interests of clinical specialists and researchers oriented towards social and behavioural sciences are linked over a broad front. It is also hoped that from this connection-embeded in open scientific discourse-"health sciences" will arise, not as part of medicine, and not as part of this social sciences, but with their own claims and specific conceptions as to how the problems of our health system can be resolved.     

Multidimensionality of oral health in dentate adults

OBJECTIVES: An understanding of the validity and usefulness of self-reported measures (as distinct from clinically determined measures) of oral health is emerging. These self-reported measures include self-rated oral health (SROH). Three objectives were to: (1) describe self-rated oral health in dentate adults, (2) quantify associations between self-rated oral health and other measures of oral health (oral disease and tissue damage, pain and discomfort, functional limitation, and disadvantage), and (3) assess the construct validity of a model of oral health proposed herein. METHODS: The Florida Dental Care Study is a longitudinal study of oral health, which included at baseline 873 subjects who had at least one tooth, were 45 years or older, and who participated for an interview and clinical examination. RESULTS: The prevalence of self-rated oral health decrements was substantial; approximately one fourth of subjects reported their oral health as only fair or poor. Bivariate and multivariate results provided consistent evidence of the construct validity of the proposed model of oral health. Additionally, the salience of one measure of dental appearance suggests that persons may use esthetic cues when rating their oral health. CONCLUSIONS: The proposed multidimensional model of oral health has construct validity. Self-rated oral health is affected by oral disease and tissue damage, oral pain and discomfort, oral functional limitation, and oral disadvantage. These self-reported measures and the proposed model should provide useful information for dental care effectiveness research. General health status has been disaggregated into the "physical" and the "mental;" an additional separation into the "oral" aspects of health seems warranted.     

Promoting health, promoting women: the construction of female and professional identities in the discourse of community health workers

Community health worker (CHW) programs are implemented in the third world and among racial minorities in the U.S. by public health professionals with the goal of improving people's access to basic health services. There is a shared view that women's roles as mothers make them effective CHWs because most health practices are located within the realm of the family. The objective of this paper is to inquire how and what concepts of woman are constructed and promoted in CHW programs. Viewing CHW as a discourse, I examine literature on CHWs using a critical feminist perspective and insights from narrative and rhetorical analyses. I argue that CHW positions women living in the third world and non-white Hispanic women in the U.S. as the "other" woman. The natural attributes of this other woman include mother, care giver, oppressed, child-like, and victim of patriarchy, religion, poverty, and diseases. These attributes are used to define categories of the female such as "the third world woman" and "Hispanic woman". These categories, in turn, define two unnamed opposite categories: "the first world woman" and "the public health professional". I conclude that CHW is a colonizing discourse and that public health professionals and feminists need to practice reflexivity.     

An in-depth look at congressional committee jurisdictions surrounding health issues

Congress plays an important role in shaping U.S. health care policy, and within Congress, committees play the lead policy-making role. To determine the range and extent of committee involvement on health issues, I examine nine health issue categories over a fifteen-year period (1979-1993) to discover how both "legislative" and "nonlegislative" committee jurisdictions differ across three dimensions: congressional chambers, committees within those chambers, and specific health issue categories. Then, to capture differences across a fourth dimension, time, I also calculate annual measures of jurisdiction "concentration" for legislative and nonlegislative jurisdictions. Together, the jurisdiction differences across the four dimensions provide a comprehensive view of congressional committee jurisdiction arrangements surrounding health issues. I find that the differences in jurisdiction across each dimension follow general patterns resulting from institution-specific factors (e.g., rules, norms) and from issue-specific factors (e.g., salience, complexity). Recognizing these dimensions and their respective patterns helps us understand the power that committees exercise over health issues.     

Mental health services in managed care: quality questions remain

Primary care physicians are often the professionals to whom older patients turn for advice about medical coverage in Medicare managed care health plans. To assist in this dialogue, these authors outline current characteristics and financial arrangements for psychiatric and mental health services in Medicare managed care. Advantages and disadvantages of Medicare managed care for enrollees with mental disorders are outlined. Mental health "carve-out" and "carve-in" models are defined, and questions are raised about the number of psychiatrists and other mental health care providers needed to provide appropriate care for a plan's enrollees.     

Working as a psychologist in the Medical Reserve Corps: Providing emergency mental health relief services in Hurricanes Katrina and Rita.

This article details before, during, and after "snapshots" of what it is like to go into a disaster to provide emergency mental health as part of the nation's emerging Medical Reserve Corps. It is a first-time responder's personal account of "lessons learned" and "priorities" for psychologists in similar situations. Twelve recommendations for improving psychologists' effectiveness in addressing widespread mental health disasters are identified. These include (a) team deployment and mission, (b) anticipation of frustrations, (c) prioritization in a disaster, (d) ethical dilemmas, (e) recognition of the benefits, (f) development of rapid screening tools to identify those in greatest need of mental health intervention, (g) training allied health professionals in mental health response, (h) mental health interventions specific to Katrina, (i) the importance of supporting caregivers and systems, (j) identifying and activating one's own support system, (k) slowing down interventions, and (l) training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The illusion of mental health.

Argues that researchers' reliance on "objective" mental health scales and disregard for clinical judgment has led to many mistaken conclusions. Specifically, standard mental health scales appear unable to distinguish between genuine mental health and the facade or illusion of mental health created by psychological defenses. Evidence is presented indicating that (1) many people who look healthy on standard and mental health scales are not psychologically healthy and (2) illusory mental health (based on defensive denial of distress) has psychological costs and may be a risk factor for medical illness. Clinical judges could distinguish genuine from illusory mental health, whereas "objective" mental health scales could not. The findings call into question the conclusions of many previous studies that rest on standard mental health scales. They suggest new ways of understanding how psychological factors may influence health. Finally, they suggest that clinical methods (which researchers often malign) may have an important role to play in meaningful mental health research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health beliefs and physician identified "worried well."

Examined health belief variables of the frequent and inappropriate user of medical services, or "worried well," in 2 studies. In Study 1, 73 health maintenance organization subscribers completed a health concern questionnaire. Results show that the physician identified "worried well" were concerned about both general and mental health issues and perceived typically minor symptoms as more serious than other frequent appropriate users, infrequent users, and mental health comparison groups. Study 2, a prospective study of 323 frequent users of health services, measured beliefs and subsequent use for 1 yr. Ratings of inappropriateness of use and psychosomatic involvement made by medical providers were predicted by high degrees of self-reported somatic symptomatology, mental health concern, belief in self-responsibility for health care, belief that one should handle one's own problems, and a limited belief in the responsibility of powerful others for health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory blood pressure in hypertension with particular reference to the kidney

OBJECTIVE: To study the relationship between individual health beliefs and risk factors for coronary heart disease. DESIGN: Health beliefs indices, formed by factorial analysis of ratings of statements on health related matters in a questionnaire, were related to risk factors for coronary heart disease, assessed with physical examinations and self reports of medical history and habits. SETTING: An urban primary care district in Malm?, Sweden. SUBJECTS: A random sample of middle-aged men, invited to a health check-up. RESULTS: The participation rate was 453/705 (64%). "Perceived threat to health caused by illness" was positively related to previous information on high blood pressure, high plasma cholesterol, and/or diabetes (p = 0.01). In a model of logistic regression, adjusted for age, cohabitation, and previous medical history, health belief index on "threat to health" was related to low exercise habits (RR = 1.06, CI 1.01, 1.12). "Perceived control over illness" was related to high alcohol consumption (RR = 0.86, CI 0.75, 0.97), smoking (RR = 0.89, CI 0.79, 0.99), and high diastolic blood pressure (RR = 0.84, CI 0.75, 0.95). CONCLUSION: This cross-sectional study demonstrates relations between health beliefs, previous health-related experiences, and risk behaviour. To explore the causality of the former, longitudinal studies of changes in health beliefs after medical information are required.     

Population-health concept challenges dominance of clinical medicine

As the emerging policy concept of population health challenges the dominance of clinical medicine in health care, many question how it will affect "grass-roots" physicians. Although primarily a planning tool for policymakers that provides a framework to study the determinants of health, health outcomes and health interventions, population health can also be applied to medical practice. The CMA identified population health as a priority issue in March 1994, and has sponsored several presentations and workshops on the issue. On Jan. 23 three CMA Councils will meet jointly to discuss the implications this new policy holds for physicians.     

Review of Psychology and Medicine: Psychobiological Dimensions of Health and Illness.

Reviews the book, Psychology and Medicine: Psychobiological Dimensions by Donald Bakal (1979). Bakal believes that psychology "is rapidly becoming an integral part of modern health care delivery systems" and directs his book toward developing this interest by showing the theoretical and practical relevance of psychological concepts to major health problems. In the first section, which has the inclusive title "Medicine: Mind and Body", he describes a "paradigm shift" in medicine, away from an emphasis on the physiological and biochemical systems as basic to understanding disease toward a "psychobiological" approach to illness which focuses on the inter-relationships between the social, psychological, and physiological determinants of health and disease. He amplifies this point by discussing such matters as personality-disease relationships, psychomatic medicine, a cross-cultural variation in models of health and illness and the implications of the split brain research for states of consciousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A point of view: why point-of-care places are not free marketplaces

Current wisdom holds that health care is a business and "as such must abide by market principles." Most nurses are not well enough versed in economic theories to credibly critique health care delivery decisions based on economic theories. The relationship of market principles to health care realities is described in basic terms to encourage nurses to "optimize patient care and influence health care policy." Physicians, who control all access points to the health care system, have enjoyed a 40-year market dominance that is "rapidly being replaced by insurance companies and for-profit investors." Providers' decisions to treat or not to treat are strongly influenced by whether the patient is in a fee-for-service or capitated payment environment.     

Ethics of the distribution of health care

While the concept of a "right to health care" has been evolving in the United States, this should be distinguished from "the right to health," guaranteed in the constitutions of many socialist countries. In an effort to promote "quality of life" for their citizens, governments can, and do provide health care, but this does not always lead to health. In so doing, governments open access to care for those previously underserved--or unserved. For the United States at this time the goal becomes one of assuring equity, which will likely be achieved by locally based private and/or governmental entities, federated for greater efficiency and regulated by federal and state governments. Such programs will be staffed by a new breed of physician, the medical student of today.     

Marital satisfaction and depression as predictors of physical health status.

Investigated the multiple correlation between physical health status and a set of marriage-related "predictor" variables. Family practice physicians provided a sample of 104 married couples (average age, 30 yrs). Marital satisfaction, depression, number of visits to physician, and educational level were among the set of cross-validated "predictors" of reported physical health status. The correlation between physical health status (the Cornell Medical Index) and depression (Zung Self-Rating Depression Scale) was significantly greater for wives than husbands. For wives, marital satisfaction (Locke-Wallace Marital Adjustment Test) and depression were related primarily through the uncontrolled variance in physical health status, whereas for husbands a significant relationship between marital satisfaction and depression remained for husbands when physical health status was partialed out. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age effects and health appraisal: a meta-analysis

OBJECTIVE: The purpose was to clarify the effects of methodological variables in the research on age differences in self-rated health and specifically the effects of: (a) the item type used to solicit the appraisal, (b) the approach to sampling, and (c) the criteria for assembling the age groups for study. METHODS: Studies differing on these dimensions were compared using meta-analytic techniques. Seventeen usable samples were grouped according to the age comparisons--seven compared "young" and "old" samples while ten compared "young-old" and "old-old" groups. RESULTS: The results failed to support the frequently reported health optimism of old-old samples when compared with young-old. Further, the findings suggest that the item type used in eliciting the rating of health may be instrumental in the respondent's appraisal process. For instance, use of the age-comparative item tends to favor "old" groups when compared to young, whereas the global health item has an effect in the other direction. Effect size was also related to a study's sampling procedure and to the method used in assembling groups (i.e., age ranges used to represent young and old). DISCUSSION: Practical implications and areas of needed research are discussed.