Health sector approach to vulnerability reduction and emergency preparedness

Vulnerability is increasing year by year. Statistics show that not only are the human and economic costs of emergencies and disasters increasing, but that the cost of relief assistance has increased 10-fold in the last 11 years. Relief assistance alone can lead to increased vulnerability, by reducing development assistance and leading to further social crises The concept of vulnerability consist of two aspects, susceptibility and resilience; vulnerability reduction aims to reduce susceptibility to hazards and increase community resilience to emergencies. Vulnerability reduction involves vulnerability assessment, hazard prevention and mitigation, and emergency preparedness. Vulnerability reduction aims to decrease community susceptibility and increase community resilience, and can focus on emergencies thus preventing many disasters. Vulnerability reduction protects human development, and prepared communities can maintain and improve their level of development. Vulnerability reduction is the responsibility of all, including the health sector, and all sectors at all levels must assist communities to participate in reducing vulnerability. The health sector work in vulnerability reduction requires coordination at all levels within a country. WHO has been assisting in this work at the international, regional and country levels for many years. There is a need for statistical indicators of vulnerability and the harm caused by major emergencies. Data from these indicators will assist in monitoring and evaluating vulnerability reduction, and targeting communities at risk.     

Needs of the psychiatric patient population in secondary and tertiary prevention: point of view of a clinician

The concept of need, discussed from many points of view, remains necessary to the planning of health services. The author tries to define psychiatric needs in a clinical perspective, limiting his approach to secondary and tertiary prevention. The critical points supporting the clinical decision permit the choice of fundamental criteria which allow one to identify and describe the psychiatric needs of a given population. Using this methodology a typology of those needs is formulated in a way which is acceptable in a multidisciplinary approach.     

Epidemiology of drug use during the first three months of life in a urban area of southern Brazil

Evidence-based evaluations of clinical preventive services help define priorities for research in prevention as part of primary health care. In this article, we draw on our experiences with the U.S. Preventive Services Task Force (USPSTF) to outline some major areas where research is needed to define the appropriate use of specific screening tests, counseling interventions, immunizations, and chemoprophylaxis. Areas of particular importance included research to: (1) Identify effective and practical primary care interventions for modifying personal health practices of patients, especially around issues such as diet, exercise, alcohol and drug use, and risky sexual behavior; (2) Clarify the optimal periodicity for certain screening tests and counseling interventions; (3) Identify practical ways to allow patients to share decision-making about preventive care, especially for services of possible but uncertain benefit; (4) Examine the most sensitive and efficient ways to identify high-risk groups who may need different services than the average population; and (5) Expand the use of decision-analysis and cost-effectiveness analysis to help identify optimal use of clinical preventive services. Given the difficulty of large, prospective trials, we discuss the use of alternative research designs to fill in critical gaps in the evidence for the effectiveness of specific services. Finally, we note several issues of increasing importance that may need to be addressed by future work of the USPSTF: what are the most reliable and effective ways to (1) measure and (2) improve the delivery and quality of preventive care provided in the primary care setting.     

Six month follow-up: the crucial test of multidisciplinary developmental assessment

Participation of parents in the developmental assessment process is thought to be beneficial in promoting understanding of their child's disability, and improving consensus between parents and professionals about appropriate intervention programmes. If costly multidisciplinary assessments are to be justified, it is necessary to establish long-term benefits for the child. This highlights a need for research identifying how families use services after diagnostic assessment and what they understand to be important for their child. Poor parent-professional agreement about diagnosis may be a factor contributing to low compliance with recommendations. The major purpose of the current study was to follow-up families 6 months after developmental assessment, in order to investigate use of recommended intervention services. In addition, mothers' opinions about diagnostic findings, recommendations and early intervention services were examined. Subjects were 40 pre-school children who presented for developmental assessment, and their mothers. The majority were diagnosed with developmental problems in multiple domains. Results indicated that most mothers recalled and agreed with their child's diagnosis, but underestimated the severity of developmental delay. Families had not accessed the range of multidisciplinary intervention programmes recommended, given the complexity of their children's disabilities. Speech therapy was considered the service of highest priority by mothers, and was the treatment most frequently received. Mothers recognized a need for more therapeutic interventions for their child. An unexpected finding was the high prevalence of families who organized nonprescribed therapies. Possible explanations of the findings and implications for service delivery are discussed.     

Social constructivist approaches for brief, episodic, problem-focused family encounters

Clinicians of many health care disciplines provide health care services to the family unit. Because of the multiple perspectives that individual family members bring to the health care encounter, family-focused primary health care presents special challenges for providers. The need to reconcile multiple individual family member perspectives requires that clinicians develop increasingly more sophisticated, effective, family intervention skills that can be used in busy primary care settings. Social constructivism can provide a means through which clinicians can quickly engage families in creating a consensus on health issues, thus leading to effective, efficient problem solving. This paper reviews the origins and principles of social constructivist thought and describes assessment questions and therapeutic stances that can be used to empower families to become active participants in the process of initiating their own health-related life changes. These approaches are useful for episodic, brief, problem-focused encounters with families in many primary care practice settings.     

Serious Emotional Disturbance in Children and Adolescents: Opportunities and Challenges for Psychologists.

Approximately 4.5 to 6.3 million children and adolescents in the United States have a serious emotional disturbance that undermines their present functioning and imperils their future. However, at least two thirds of young people with a diagnosable mental disorder receive no services at all. Responding to this unmet need, psychologists are assuming new roles in a changing mental health marketplace and are adopting new intervention strategies to work with these children, adolescents, and their families. This article addresses the scope of the problem, opportunities and challenges for practitioners, the larger context of professional practice, future directions, and suggestions for psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Job control mediates change in a work reorganization intervention for stress reduction.

This longitudinal, quasi-experiment tested whether a work reorganization intervention can improve stress-related outcomes by increasing people's job control. To this end, the authors used a participative action research (PAR) intervention that had the goal of reorganizing work to increase the extent to which people had discretion and choice in their work. Results indicated that the PAR intervention significantly improved people's mental health, sickness absence rates, and self-rated performance at a 1-year follow-up. Consistent with occupational health psychology theories, increase in job control served as the mechanism, or mediator, by which these improvements occurred. Discussion focuses on the need to understand the mechanism by which work reorganization interventions affect change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Including the family perspective in sensory integration outcomes research

Occupational therapy, along with other health and rehabilitation professions, is experiencing an increased emphasis on measurement of intervention outcomes. The results of outcomes research are being used to develop practice guidelines, set standards for reimbursement, and justify health care policy. The outcome assessments used by therapists reflect our belief systems and the assumptions about behaviors we expect to influence. Using a sensory integration perspective to illustrate key points, we present a conceptual framework that is based on the disablement framework and Coster's occupational functioning for children model. We highlight the need to examine each of the multiple levels at which intervention may influence child and family function and the links among levels. Sensory integration theory and efficacy studies are reviewed to identify assumptions relative to how sensory integration affects the everyday occupations of children in the context of their families. Potential research methods and assessments are suggested to include the family perspective in outcome studies.     

Basis for decisions on emerging health technology. A Danish feasibility study

The objectives of the feasibility study were to evaluate sources of information for an eventual Danish system for early identification and assessment of emerging health technology, to identify potential users of the system, and to clarify their specific need for information concerning emerging health technology. The methods used were questionnaires to informants within and outside the health services and to decision makers on different levels in the health services, and follow-up telephone interviews. Our study reveals a strong, and to some extent unsatisfied, need among policy makers, planners, and managers in the Danish health services for information concerning emerging health technology. The requested information should in particular concern indication for use, number of patients affected, clinical effectiveness and side effects, running cost, and investments. The time horizon most relevant to the decision makers seems to be only zero to 2 years. Furthermore, we found that numerous sources are available that frequently display information on emerging technology important to the health services. The challenges seem to be to select information of sufficient importance and quality, and to combine information, since very few, if any, single primary sources cover all the requested information. In conclusion, we recommend the establishment of a Danish national system for early identification and assessment of emerging health technology, consisting of a small secretariat that collaborates nationally and internationally, the latter in particular on identification of technology and on development of methods for early assessment.     

A survey of job satisfaction, sources of stress and psychological symptoms among general practitioners in Leeds

BACKGROUND: The past seven years have seen rapid changes in general practice in the United Kingdom (UK), commencing with the 1990 contract. During the same period, concern about the health and morale of general practitioners (GPs) has increased and a recruitment crisis has developed. AIM: To determine levels of psychological symptoms, job satisfaction, and subjective ill health in GPs and their relationship to practice characteristics, and to compare levels of job satisfaction since the introduction of the 1990 GP contract with those found before 1990. METHOD: Postal questionnaire survey of all GP principals on the Leeds Health Authority list. The main outcome measures included quantitative measures of practice characteristics, job satisfaction, mental health (General Health Questionnaire), and general physical health. Qualitative statements about work conditions, job satisfaction, and mental health were collected. RESULTS: A total of 285/406 GPs (70%) returned the questionnaires. One hundred and forty-eight (52%) scored 3 or more on the General Health Questionnaire (GHQ-12), which indicates a high level of psychological symptoms. One hundred and sixty GPs (56%) felt that work had affected their recent physical health. Significant associations were found between GHQ-12 scores, total job satisfaction scores, and GPs' perceptions that work had affected their physical health. Problems with physical and mental health were associated with several aspects of workload, including list size, number of sessions worked per week, amount of time spent on call, and use of deputizing services. In the qualitative part of the survey, GPs reported overwork and excessive hours, paperwork and administration, recent National Health Service (NHS) changes, and the 1990 GP contract as the most stressful aspects of their work. CONCLUSIONS: Fifty-two per cent of GPs in Leeds who responded showed high levels of psychological symptoms. Job satisfaction was lower than in a national survey conducted in 1987, and GPs expressed the least satisfaction with their hours, recognition for their work, and rates of pay. Nearly 60% felt that their physical health had been affected by their work. These results point to a need to improve working conditions in primary care and for further research to determine the effect of any such changes.     

Second malignancies in cervical cancer patients in the west of Scotland

A recent focus in health care is to develop a seamless transition for patients between the variety of health care agencies with whom they interact. The continuum of care for patients with stroke is complex and many levels of care are required, from acute intervention through to rehabilitation and reintegration into the community. A group of nurses from a variety of agencies in Southwestern Ontario received funding from the Ontario province Wide Nursing Project to effect a desirable change in the way nurses care for the stroke patient. This article describes the Ontario Province Wide Nursing project and the process of and challenges in developing a nursing model for stroke. The development of a nursing model for stroke patients and their families involved conducting nursing, and patient and family focus groups to identify key issues. Thirty-eight nurses participated in the nursing focus groups, and 8 patients and 18 family members participated in the patient and family focus groups. The common themes were the need for improved communication and the need to better prepare patients and families for the many transitions they experience during their recovery from stroke. A Stroke Education Record, which identifies a comprehensive list of potential learning needs of stroke patients and their families, and a Stroke Education and Resource Guide, which provides a reference for nurses, were developed and will be implemented in September 1998. Implementation of the model included a workshop, staff inservices, a self-learning package, and unit displays. Evaluation of the model will include nursing and patient and family focus groups, a chart review, written nursing evaluations, and patient and family telephone interviews.     

Strengthening mental health services in Head Start: A challenge for the 1990s.

Steps must be taken to strengthen mental health services by building on Head Start's philosophy and by translating innovations in mental health services for older children and adolescents into improved services for young children and their families. Recommendations for strengthening Head Start's mental health program include creating a unified vision that reaffirms a holistic, family-focused, and comprehensive services approach; ensuring that mental health services are responsive to the diversity in families served; increasing coordination of mental health services and linkages with new initiatives; increasing resources and providing assistance in gaining access to new sources of funding; supporting innovation; and integrating the new paradigm for children's mental health services into more traditional approaches to intervention within Head Start. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of an innovative program to address the health and social service needs of drug-using women with or at risk for HIV infection

Drug-using women with or at risk for HIV infection have many competing unmet needs, especially for social services, drug treatment, and medical care. High-risk drug-using women were recruited through street outreach, at needle exchange sites, a prison, and local community based organizations in New Haven, Connecticut for a study of the service needs of out-of-treatment drug users and the ability of an interactive case management intervention (ICM) to address those needs. These women were administered baseline and follow-up interviews to identify their health and social service needs and the degree to which these needs were resolved. The women who chose to enroll in the interactive case management intervention (n = 38) did not differ demographically nor in their HIV risk behaviors from those not receiving case management (n = 73). Provision of ICM was most successful in meeting needs for supportive mental health counseling, basic services, and long term housing. The impact of interactive case management was less evident for the acquisition of medical and dental services, which were accessed comparably by women not receiving the intervention. Overall, the women who enrolled in the ICM intervention showed a significant decrease in the number of unmet service needs as compared to those who did not enroll. Multiple contacts were required by the case manager to establish trust and to resolve the unmet service needs of these high-risk women. Women with or at risk for HIV infection can be effectively engaged in an ICM intervention in order to meet their multiple unmet service needs, although such interventions are time-and-labor intensive.     

Adapting clinical services to accommodate needs of refugee populations.

The diversity of the refugee population in the United States requires practicing psychologists to respond by adapting clinical services to meet their mental health needs. However, the available literature on culturally adapted treatments is only a first step in guiding the process for adapting clinical services. This paper describes our experiences with designing and adapting a variety of clinical services for youth and families with refugee status. Guided by Sue's (2006) tenets for culturally competent service delivery, we discuss a therapeutic model of tiered service delivery used to deliver preventative services and treatment to refugee youth and adults. We discuss how we adapted treatments to help overcome access barriers to mental health treatment, and we provide specific examples of how existing treatments were used with refugee populations. In addition, we discuss information and approaches for how practicing psychologists can develop additional skills for working with refugee populations. We conclude by focusing on the need for our field to work toward improving access to mental health treatment for refugee youth and families and developing evidence-based treatments for this population. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Understanding stress and burnout in shelter workers.

Crisis intervention workers and other front-line mental health workers often face excessive stress and seek psychotherapy or supervision and support from professional psychologists. The authors sought information on job-related stressors, coping mechanisms, and burnout levels and found that shelter workers who reported high job-related stress and low social support may be most vulnerable to experiencing burnout symptoms. Psychologists providing clinical or consultation services to domestic violence shelter staff should emphasize the importance of creating a supportive work environment, developing a sense of personal accomplishment related to one's work, and teaching and modeling helpful coping strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of indicated preventive intervention (secondary prevention) mental health programs for children and adolescents

Evaluated the outcomes of 130 indicated preventive interventions (secondary prevention) mental health programs for children and adolescents that seek to identify early signs of maladjustment and to intervene before full-blown disorders develop. Results indicate such programs significantly reduce problems and significantly increase competencies. In particular, behavioral and cognitive-behavior programs for children with subclinical disorders (mean ESs in the 0.50s) appear as effective as psychotherapy for children with established problems and more effective than attempts to prevent adolescent smoking alcohol use, and delinquency. In practical terms, the average participant receiving behavioral or cognitive-behavior intervention surpasses the performance of approximately 70% of those in a control group. Of particular interest was the high mean effect (0.72) achieved by programs targeting incipient externalizing problems which are customarily the least amenable to change via traditional psychotherapeutic efforts when they reach clinical levels. Priorities for future research include greater specification of intervention procedures, assessment of treatment implementation, more follow-up studies, and identifying how different participants respond to early intervention.     

Factors associated with child mental health service use in the community

OBJECTIVE: To determine the association of parent, family, and child factors with mental health services need and utilization. METHOD: Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. RESULTS: 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. CONCLUSION: Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.     

Effect of community based management in failure to thrive: randomised controlled trial

OBJECTIVE: To evaluate the effectiveness of a health visitor led intervention for failure to thrive in children under 2 years old. DESIGN: Controlled trial, randomised by primary care practice. SETTING: Newcastle upon Tyne health district. INTERVENTION: Structured health visitor management, with dietetic, paediatric, and social work input as required. SUBJECTS: 229 children (120 in intervention practices and 109 in control practices) were identified as failing to thrive by population screening during the first 2 years of life. Follow up was by home visit of a research nurse and review of the childrens' records at age 3 years. MAIN OUTCOME MEASURES: Follow up weight and height and number of routinely collected weights. RESULTS: 95 of the 97 families offered intervention completed at least the initial assessment. At follow up, 187 (82%) records were reviewed, and these suggested that 15 (16%) controls were lost to follow up immediately after the screening weight was taken compared with only one child in the intervention group. In the 134 (58%) families who consented to home visits, children in the intervention group were significantly heavier and taller and were reported to have better appetites than childen in the control group, although both groups were equally satisfied by the services they had received. When the children were last weighed, 91 (76%) in the intervention group had recovered from their failure to thrive compared with 60 (55%) in the control group (P<0.001). CONCLUSION: In failure to thrive, health visitor intervention, with limited specialist support, can significantly improve growth compared with conventional management.     

Roles for Psychologists in End-of-Life Care: Emerging Models of Practice.

Professional psychologists are increasingly likely to encounter opportunities to work with patients and families facing end-of-life issues. Psychologists can provide psychological assessment, intervention for patients and families, consultation with and support of health care team members, grief therapy, and program development and evaluation. Psychological services are useful for healthy individuals who wish to make thoughtful plans about their own future care, patients with life-limiting illnesses, families stressed by providing end-of-life care, bereaved individuals, and health care providers who face issues of burnout and strain. Several challenges for psychologists working in end-of-life care are noted, including training, development of clear roles, and reimbursement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transgenic rice plants harboring an introduced potato proteinase inhibitor II gene are insect resistant

BACKGROUND: Previous studies suggest that injury prevention counseling by pediatricians is effective but accomplished infrequently. The Framingham Safety Surveys (FSS) are brief questionnaires designed to facilitate physician education of parents regarding injury prevention. OBJECTIVE: To determine whether the FSS improve pediatricians' injury prevention counseling. DESIGN: Nonrandomized comparison of a 4-week baseline period and subsequent intervention periods. SETTINGS: Private practice; university hospital clinic. PATIENTS: Patients coming for health supervision visits. INTERVENTION: Provision to the physician of one of the FSS, completed by the parent just before the health supervision visit. OUTCOME MEASURES: (1) After each visit parents completed a checklist of safety issues discussed by the pediatrician. Injury prevention was compared for the two periods by means of three criteria: number of issues discussed (quantity), identification and discussion of specific high-risk behaviors (efficiency), and recognition of high-risk families (targeting). (2) Each physician's assessment of the value of the FSS was obtained by questionnaire. RESULTS: A total of 144 parents (50 from the private practice, 94 from the clinic) completed checklists during the baseline period, and 168 (38 from the private practice, 130 from the clinic) during the intervention period. Use of the FSS produced no detectable improvement in any of the three measures. Seventy-seven percent of the physicians indicated that the FSS were helpful in educating families about safety, 38% thought that the FSS helped identify high-risk families, and 54% said they would use it again. CONCLUSIONS: Although most physicians believed the FSS were useful, introduction of the surveys as employed in this study did not improve injury prevention counseling.