Cultural barriers to health care reform

The rate of proliferation of health care reform proposals makes it impossible to consider them all adequately; whatever plan is finally legislated, there will be many who are not satisfied with it, and clamor for change is likely to be a prominent feature of health care politics for a long time. This article takes a brief look at the health care reform process in the United States, including some of the impediments to development of a plan that would address both contemporary and future issues. Some traditional ethical viewpoints and cultural values, having to do with concepts of justice, are seen as inimical to long-range program development. The need for alteration of traditional views is regarded as urgent, to facilitate cultural movement in directions that will not only permit development of workable health care programs, but will extend broadly to address other compelling societal issues. The impetus for advantageous cultural movement originates among perceptive individuals who are regarded by society as legitimately influential. Many physicians still are accorded this sort of recognition, and the considered input of medical professionals is essential.     

Teenage health and the practice nurse: choice and opportunity for both?

Teenage health issues and the means to address them have caused increasing concern over recent years. This study investigated the involvement and training of practice nurses, the topics raised during consultations with teenagers, and the comfort of the practice nurses in dealing with these topics. Data were collected using a postal questionnaire survey (response rate 80.6%). Expansion of the role of the practice nurse in teenage health may be appropriate but needs to be supported by training.     

A research program for accountable and patient-centered health outcome measures

This article addresses the relevance of probabilistic conjoint (Rasch) measurement to five issues of accountability and patient-centeredness in health care. Goals for research, data quality standards, and standard metrics are proposed. The article is intended to begin to address concerns voiced by health care researchers, policy analysts, and the public about ways in which health care outcome measures can be improved.     

Divided No More: Psychology's Role in Integrated Health Care.

Health-care providers increasingly recognize the need to address behavioural and emotional influences on physical health in order to provide quality and cost-effective services. As behaviour change experts, psychologists can be critically important in new models of integrated care that focus on both physical and psychological health. However, to be effective, psychologists must be prepared to address the major issues facing health-care systems today and be willing to re-examine and modify current modes of education and practice. This article describes important trends affecting health care and the ways in which psychologists could contribute. Lastly, two psychologists involved in new models of integrated care describe their training and the challenges and rewards of their current activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharyngeal wall vibration detection using an artificial neural network

OBJECTIVES: To assess the likelihood of health care legislation in the forthcoming 105th Congress in 5 areas: health care coverage, tax and Employee Retirement Income Security Act (ERISA) policy, Medicaid, Medicare, and managed care. DESIGN: Informal, semistructured conversations that took place in the months prior to the 1996 elections. POPULATION: Congressional health staff and administration officials. OUTCOME MEASURES: Unofficial, off-the-record personal opinions. RESULTS: Health care coverage initiatives to benefit children and unemployed persons are likely to be proposed, but have little chance of enactment; children are seen as well provided for under current Medicaid law, the strong economy and high employment levels lower concern for unemployed issues, and the effort required to pass the Kassebaum-Kennedy legislation needs time to settle. Tax proposals, such as medical savings accounts (MSAs), and ERISA amendments have no constituency; also, the MSA demonstration in Kassebaum-Kennedy will forestall further action. Medicaid is far less an issue than in the previous Congress, because spending has fallen unexpectedly, the bitter fight over block grants makes them unlikely to be revisited, and the administration is likely to enhance state flexibility through waivers. Medicare will be the subject of substantial action to defer impending insolvency temporarily, but there is virtually no chance that definitive long-term solutions will be enacted even though the underlying fiscal problems are thoroughly understood and recognized. Managed care will be the venue for numerous proposals designed to address specific consumer and quality issues. CONCLUSIONS: Four bitter years of fighting over health care issues has raised awareness of the problems, but has produced a political chemistry that is too rancorous to permit passage of significant legislation in the near future.     

Health Psychology: The time is now.

Based on his presidential address delivered to the Division of Health Psychology in 1980, the author (1) reviews factors responsible for the current state of issues affecting health and illness; (2) assesses the future of health research, clinical application, training, and employment opportunities; and (3) discusses 3 modulator issues that may determine effectiveness and capacity to meet the future health challenges. Three major themes emerge that are affecting health issues: Costs are out of control; chronic illness has become the greatest concern; and the development of consumerism and self-management strategies are affecting health care. The author discusses commitment, ethics, and the concept of the health model as they affect health psychology. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resuscitation. Nurses' skills in basic life support: a survey

Cardiopulmonary resuscitation (CPR) skills are fundamental to the function of health professionals, but studies have shown them to be inadequate and outdated. This week, Nursing Standard launches a three-part weekly series on resuscitation. Parts two and three will address the associated ethical issues and measures of outcomes and accountability. The series begins with a survey in a district general hospital which aimed to establish nurses' levels of awareness on the current recommendations for CPR laid down by the Resuscitation Council of the UK. The results show a poor knowledge level and recommendations are offered.     

Women's oral health issues: an exploration of the literature

As interest in women's health issues grows, there is increasing concern that today's practice of medicine may not meet the health needs of women. A primary reason is the gender bias that has been inherent in medical education, research and clinical practice. The prevailing medical viewpoint has often been that the male body is considered to be the norm and that the female body exactly the same except for the reproductive function. This attitude has led to a lack of interest in researching gender differences and a consequent lack of knowledge of women's health issues. Fortunately, there is a movement for change. The Women's Health Interschool Curriculum Committee was formed in January 1992 to develop curricula concerning women's health and examine bias that may exist in existing curricula. The Canadian Women's Health Network has been growing across the country and there have been calls to create a new specialty in women's health. According to Angell, this proposal for a new specialty was provocatively debated in the Journal of Women's Health, which started publication in 1992. There is also a growing concern on how to conduct better research to address women's health needs. As more attention is paid to women's health issues, what will happen in the area of oral health? In health care, it would seem that the mouth has become completely separated from the rest of the body. Health conferences rarely have any oral health content at all. To correct this problem, there must be an increase in general awareness of the importance of oral health as it relates to the overall health of both women and men. Good oral health is more than just decay-free teeth. Oral health encompasses the teeth, the supporting periodontal structures, soft tissues of the mouth and oral pharynx area, temporomandibular joints and muscles of mastication. The mouth is a gateway to the body and will also reflect many systemic health problems, such as diabetes, leukemia and lupus. The second step would be the recognition that women may have different oral health needs and issues than men. The common view may be that teeth are gender free, but how can this be when teeth exist in a body, and that body is male or female? For many years, the primary acknowledged difference between men and women's oral health was pregnancy gingivitis. Like medicine, dentistry must re-examine the viewpoint that women's oral health differs from men's only as it is influenced by reproductive processes. There are many areas where women's oral health may differ from that of men. This paper will explore the literature for potential women's oral health issues in the areas of oral hygiene behaviours, esthetics, eating disorders, temporomandibular disorders, and hormonal influences on periodontal health.     

Measuring health and economic status of older adults in developing countries

Aging and health care are the emerging policy issues in the Third World. However, we currently do not have the data to address these issues because economic status and health have not been integrated into a single survey design. This article discusses the rationale for the principal features of an emerging new international survey design which includes integration of younger and older families; reliance on retrospective data; intensive measurement of economic status, health outcomes and utilization and intergenerational transfers; and the combination of a household and community survey.     

Towards anti-oppressive practice in mental health nursing

Working in Partnership, the Department of Health's report on the 1994 review of mental health nursing, implies that mental health nurses should develop anti-oppressive approaches to nursing practice. There is a notable absence of articles within the nursing literature which specifically address this issue. This is possibly because the historical and ideological issues which have informed the development of mental health nursing are complex and difficult to unravel. However, an integration of the theories of David Cooper and Frantz Fanon may provide an appropriate starting point for the development of a theory of anti-oppressive practice which addresses some of the issues specific to mental health nursing.     

Coercion in the community: issues for mature treatment systems

Coercion in community-based mental health treatment refers to much more than just court-ordered treatment. Mature systems can address these issues and adopt clinical approaches that decreased the need for coercion.     

Strategies for the nurse executive to keep the rural hospitals open

Rural hospitals are confronted with multiple challenges to survive in the competitive health care environment of today's world. Declining population, corporate mergers and downsizing, transportation, cost of technology, and health manpower shortages are only a few of the issues rural hospitals must be prepared to address in order to survive. Federal- and state-administered programs are available that can contribute to the survival of the rural hospital. The nurse executive has a key role in contributing to the planning, development, and implementation of survival strategies.     

Rural women. Lifestyle and health status

This article presented a "snapshot" of the concerns and issues confronting America's rural women. The discussion highlighted demographic, economic, and sociocultural factors that impact the health status of women living in diverse rural environments. Recommendations were proposed to assist nurses to better address the health concerns of these women.     

Occupational health promotion programs to reduce cardiovascular risk.

This article surveys the literature on worksite health-promotion programs that target cardiovascular risk factors. We review findings in the areas of health-risk appraisal, hypertension control, smoking cessation, weight reduction, and exercise. Programs that address multiple risk factors are also discussed. In each area we discuss what is currently known, highlight exemplary studies, and identify both problems and priorities for future research. Increased attention needs to be paid to motivational and organizational issues that may influence participation in and outcomes of health promotion programs. The initial results in several areas (e.g., smoking cessation, hypertension control) are promising, but additional controlled research is needed to substantiate the optimistic claims that have been made about occupational health promotion. In particular, studies that evaluate impact on all employees in an organization are recommended. Clinicians and researchers also need to appreciate the unique political, logistical, and methodological issues posed by worksite programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Educating APNs for implementing the guidelines for adolescents in Bright futures: guidelines of health supervision of infants, children, and adolescents

As the scope of what constitutes health and the range of determinants of health-promoting and compromising behaviors among adolescents are expanded, APNs must be well prepared to be powerful influences in the lives of all adolescents. The guidelines offered by Bright Futures challenge nurse educators to prepare APNs who possess the core competencies to knowledgeably address the health issues and concerns of all adolescents in multiple settings. The American Academy of Nursing Expert Panel's recommendations contained herein, if implemented, will further enhance the capabilities of graduate programs to prepare APNs to provide developmentally and culturally relevant disease prevention and health promotion care to adolescents and their families.     

A rural perspective on health care for the whole person.

The authors summarize the health care problems facing rural and frontier America by addressing five key issues within the framework of health care for the whole person: how to (a) provide health care access, (b) ensure health care quality, (c) provide a range of health care or meet the scope of practice demands, (d) address regional, rural-specific characteristics that may exist, and (e) address health professionals' quality of life. When working in rural and frontier areas it is crucial for providers to collaborate across all types of health care to provide better care and better utilize a region's tautly stretched resources. Rural health care resources are provided. The authors attempt to demonstrate characteristics of rural culture and rural and frontier populations' health care disparities, highlighting the need for collaborative care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Le régime d'assurance-maladie du Canada--Arrive-t-il à un tournant?

Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced. One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field. Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health psychology at the crossroads.

Reviews the books, Handbook of psychology and health, volume I: Clinical psychology and behavioral medicine: Overlapping disciplines, edited by R. J. Gatchel, A. Baum, and J. E. Singer (see record 1985-97683-000); Handbook of psychology and health, volume II: Issues in child health and adolescent health, edited by A. Baum and J. E. Singer (1982); and Introduction to medical psychology by J. C. Norton (1982). The conflict between the traditional medical model and the biopsychosocial model threatens to prevent the establishment of health psychology's principles and identity. This conflict clearly characterizes the volumes presently under review. James C. Norton's Introduction to medical psychology aims to introduce mental health professionals to medicine, to teach behavioral treatments for disease, and to address issues of health promotion. The Handbook of psychology and health is a much more ambitious attempt to meet the same goals. The volumes are "intended for investigators, clinicians, teachers, and both graduate and undergraduate students." Given tradition, simplicity, inertia, and existing status structures, the traditional medical model has an almost overwhelming allure. Unfortunately, the traditional medical model also is inadequate, and its deficiencies cannot be remedied by forcing psychological and behavioral problems into its mechanistic clutches. By carefully reviewing and evaluating complex issues in health psychology while simultaneously endeavoring to prescribe clinical and medical treatments, the volumes under review delineate the dilemma facing health psychology; but they do little to resolve it. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Canada's Medicare--At the crossroads?

Canadians' support for the underlying values and structures of medicare still remains extremely high, according to all recent public opinion studies. However, their confidence is being tested by the persistent advocacy that increased private-for-profit payment and delivery be introduced in order to guarantee medicare's future sustainability. Patience is further being challenged as the public eagerly awaits (but does not yet sees) productive reforms actually being implemented into the system. Delay erodes public support. Alternative "solutions" gain currency. Thus, the public-private debate must be engaged fully and emerge from the shadows of public policy so that Canadians can determine its efficacy and its compatibility with our society's values. Therefore, the long overdue reforms also need to be advanced. One of the most urgent reforms to medicare should address mental health needs and concerns, which I have described as being "an orphan of medicare." An essential first step would be to construct a basic platform of care and research on issues of mental health. This platform would provide necessary, immediate services for those in need and, at another level, would provide the impetus for further solutions to the wide-ranging needs in this field. Overall, the snail's pace of reforms has caused many Canadians to speculate that the future of medicare is at the crossroads on mental health policies and other issues, like accountability, quality, adequate reporting and health outcomes. The time to act is now. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent pregnancy prevention in managed care

Efforts by the US government, employers, and insurance industry to address women's health issues have neglected the problem of adolescent pregnancy. 30 million of the 37.4 million US adolescents have health insurance coverage and 20-40% of them are enrolled in managed care plans, either through private insurance or Medicaid. Each year, managed care insurance plans pay for 150,000-300,000 adolescent pregnancies, half of which end in a live birth. There are many gaps in current approaches to adolescent health care that can be filled by physicians and managed care organizations. Prevention of adolescent pregnancy would have immediate, cost-effective results. Managed care insurance, with its organizational structure, has the potential to address the traditional obstacles to adolescent reproductive health of lack of confidentiality and difficulties with access. An adolescent health care coordinator could be hired to track teen care within the insurance plan, educate staff, and arrange and enforce protocols. It would be instructive to see whether such case management could achieve reductions in repeat adolescent pregnancies by targeting follow-up activities to this risk group. Finally, managed care organizations should analyze teen pregnancy prevention programs in their own setting and select the most effective interventions on the basis of cost and medical outcome rather than political expediency.