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.     

The PDSA cycle at the core of learning in health professions education

BACKGROUND: The Plan-Do-Study-Act (PDSA) cycle lies at the heart of continuous improvement and is a redefinition of the scientific method for application to the world of work. HEALTH CARE AS A CONTEXT FOR HEALTH PROFESSIONS LEARNING: Educational institutions could create the best "quality learning" environments for students by relating closely to health care organizations that create improvement environments for workers. When both become "learning" organizations and develop a relationship with each other, an important product will be the integration of processes for individual and organizational learning. THE PDSA CYCLE AS LEARNING THEORY: The PDSA cycle can be an integrating theory for both individual and organizational learning. It shares basic features of well-accepted theory about individual and organizational learning, including the concepts of change and action/reflection. EVALUATING LEARNING THROUGH PDSA CYCLES: An illustration is given of one set of implications of the PDSA cycle as learning theory. It describes an alternative way of thinking about the evaluation of learning, which surpasses the traditional emphasis on judgment in evaluation. CONCLUSIONS: The potential to place the PDSA cycle at the core of learning in health professions education is great. Contributing factors to this potential include the historical emphasis on the scientific method in health care, the relationship between clinical education and practice, recent improvements in our capacity to define and measure health outcomes, emergent pressures for change in health care and education, and compatible multiple functions of the PDSA cycle.     

Achievements and prospects in railway transport hygiene

A unique Institute of Railway Hygiene was created 70 years ago in Russia, one of the major railway countries in the world. Since then the Institute's staffers have carried out huge work on improvement of railway workers' health, prevention of their exposure to noise, unfavorable microclimate, vibration and other occupational hazards. Significant contribution into the world occupational hygiene was made by such Institute's professionals as S.F. Kazansky, P.I. Nikitin, A.M. Volkov and others.     

Globality and constructions of world health

Explorations of the social construction of health and illness reveal that popular and professional discourses on health and disease implicitly contain underlying images of how societies can or should be structured. Globality, which is a notion that refers to the consciousness of the world as a single place, suggests that these images of world structure are now salient. This article describes four current discourses of "work health" and discusses them in terms of their underlying ideal images of world order. The four images of the world are defined in terms of four elemental points of reference: individuals, societies, the system of societies, and humankind. These ideal images have either a gemeinschaft (community) or gesellschaft (society) orientation. An anthropology of globality can refine and extend our understandings of discourses of world health. Sensitivity to these discourses and their world-oriented ideological roots should help to demystify the notion of world health.     

International Humanitarian Award: Karen L. Hanscom.

Karen L. Hanscom received the 2001 International Humanitarian Award. She was given this award for her commitment to human rights, to the healing of torture victims, and to educating the world community about torture. She has touched the lives of hundreds of women who survived the civil war in Guatemala through her work with the Puentes de Paz health project. Her training programs have contributed to increased understanding of the needs of torture victims by a wide variety of professionals and community groups. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The role of exhaustion and workarounds in predicting occupational injuries: A cross-lagged panel study of health care professionals.

Occupational injuries remain an important concern for employers, particularly in the health care industry where injury rates have increased despite decreases in other industries. Testing the notion of resource investment from conservation of resources theory, I predicted that exhaustion would be associated with a greater likelihood of safety workarounds (alternative work processes undertaken to “work around” a perceived block in work flow, such as a safety procedure). Furthermore, I hypothesized that safety workarounds would lead to a greater frequency and severity of occupational injuries. I found support for this mediation model with a 2-sample, 3-wave survey study of a variety of health care professionals (nurses, sonographers, and others). I discuss the implications of this research for future research in occupational safety and provide ideas for the reduction of injuries through action research strategies that reduce burnout and workarounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Illusion and well-being: A social psychological perspective on mental health.

Many prominent theorists have argued that accurate perceptions of the self, the world, and the future are essential for mental health. Yet considerable research evidence suggests that overly positive self-evaluations, exaggerated perceptions of control or mastery, and unrealistic optimism are characteristic of normal human thought. Moreover, these illusions appear to promote other criteria of mental health, including the ability to care about others, the ability to be happy or contented, and the ability to engage in productive and creative work. These strategies may succeed, in large part, because both the social world and cognitive-processing mechanisms impose filters on incoming information that distort it in a positive direction; negative information may be isolated and represented in as unthreatening a manner as possible. These positive illusions may be especially useful when an individual receives negative feedback or is otherwise threatened and may be especially adaptive under these circumstances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology: New directions? Reflections on the profession and the journal.

It is with a mixture of joy and sadness that I bid farewell to the editorship of Rehabilitation Psychology. I am sad because the journal has been a stepchild to whom I offered renewed life 5 years ago. I have watched it grow and develop over those 5 years from a fledgling infant, totally dependent on me, to an adolescent just on the brink of establishing its own identity in the world of scholarly publications. I believe the editor carries a great responsibility to help define the field, expand its horizons, and encourage publication of work that will cause policy makers, researchers, and clinicians alike to turn to the journal and the profession for answers to questions we can rightly answer. Therefore, the next step in the journal's life will be an important one, not only for the journal itself, but for the profession. If the journal can help our profession meet these challenges, then I believe we will see rehabilitation psychology established as one of the leaders among the health care professions. Other disciplines will look to the journal for guidance on a broad array of issues in the health care domain, and growing numbers will proudly identify themselves as members of that leading field, Rehabilitation Psychology. For this reason, I am pleased to pass the journal on to a new editor, one who can meet these challenges successfully. With sincere gratitude for the help and support given to me as editor by the editorial board, consulting reviewers, and the Division of Rehabilitation Psychology, I bid farewell to Rehabilitation Psychology and welcome Dr. Mike Eisenberg as editor, beginning with Volume 32, 1987. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening women for chlamydia trachomatis in family planning clinics: the cost-effectiveness of DNA amplification assays

This study illustrates that cultural differences arise among similarly trained health professionals. Health professionals must learn to communicate sensitively with colleagues from other cultures, to respect their values, and to recognize and resolve cultural differences that affect patient care. In this shrinking, multicultural world, health professionals cannot afford the comfortable illusion that all similarly trained practitioners share the same values about the care of patients and professional conduct.     

The mental image.

Although neglected by cognitive psychologists, mental imagery appears to have played a crucial role in far-reaching scientific developments. Without assuming anything about the internal processes underlying visual images, such images can be studied in relation to their corresponding external objects. The results from a series of previously conducted experiments indicate that mental imagery is remarkably able to substitute for actual perception. Ss made the same judgments about objects in their absence as in their presence; Ss who imagined a particular object were uniquely fast and accurate in discriminatively responding to related external test stimuli, and in the process of imagining a spatial transformation, Ss passed through states with a demonstrable one-to-one relation to corresponding states in the external world. Rules governing spatial structures and transformations, having been incorporated into our perceptual machinery by eons of evolution in a 3-dimensional world, are now at the service of creative thought. (61 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Female physicians in Mexico: migration and mobility in the lifecourse

To date there have been few studies of professional women in health care in the developing world. With the increased feminization of the Mexican health work force, an estimated 30 per cent of all physicians are female, there is an urgent need to study this group of workers in terms of their impact on the health service. In particular, the potential for female physicians to migrate could have a dramatic impact on the health service. Indeed, it has long been recognised by the Mexican health authorities that there is an uneven spatial distribution of physicians and yet little is known about the distribution and mobility of female physicians. To this end this paper will analyse the migration and mobility of female physicians through the lifecourse in provincial Mexico. The paper examines the factors that control and structure female physician migration in childhood, during their training and career development. Data for this study were obtained during a period of ten months fieldwork in Mexico. Primary data were obtained from interviews with a sample of physicians in five study states. The interviewees also completed a diary for three months to outline their daily, weekly and monthly routine activities. Secondary data sources were various health employment records, medical school output statistics and the Atlas of Professionals produced by the Mexican census service. Material presented in this paper demonstrates that female physicians in provincial Mexico are not highly mobile. A lack of mobility is due to the constraining factors of education, gender, institutional structures and family and household imperatives.     

Finding New Functions in Society.

McKeachie (1972) commented that our graduate departments should continue to turn out psychologists despite the tightness of the job market. He asserted that we have a responsibility to train them with openness of expectations and for accession of transferable skills to work on the many human problems which are found outside academia. That Comment had particular relevance for me, and I would like to offer a specific instance of his general point. I completed much of the course work and internship requirements for a PhD in clinical psychology, and then finished the degree with a major emphasis in industrial psychology and a minor in statistics. Because I wanted to live in Idaho's unspoiled environment, I accepted a job as a management consultant with the accounting firm of Ernst & Ernst. In order to survive in the Ernst & Ernst environment, and with generous support from the partner in charge of that office, I was assisted at considerable cost to the firm in acquiring sufficient course work in accounting to qualify for the CPA exam (which I failed miserably). After three and one-half years, I began a diversified private consulting practice. All of my work is psychological, but one current project seems tailored to my checkered past. I am acting as an associate director of a community mental health center which includes supervision over the design and installation of management information, and of general and cost accounting systems. Today, I acted as an interpreter in a discussion between the director of the clinic and two accountants who, though experts in health care costs and systems, were unaware of mental health concepts and problems. The success of my work in this area rests on the three-legged stool of accounting and clinical and industrial psychology. Most of my assignments are like that, and I am having the time of my life. This is what I believe McKeachie meant by finding "new functions in society." McKeachie is correct. There are dozens of human problems to be solved, at least in the nontraditional setting in which I find myself. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-psychology as psychology: The revision of Heinz Kohut.

Our contemporary period is marked by what Wallerstein (1982, p. 9) has called "the great metapsychological debate." That is, many of the changes shown today strike at the very heart of psychoanalysis, through a questioning and reformulation of many of its basic assumptions,through creative re-readings, or in some cases transformations in what was thought to be the very essence of analytic work. However diverse these new directions may be from one another, they appear united in one respect: to unhinge psychoanalysis from its classical approach, and provide alternative metapsychological visions more faithful to human psychological life, as that transpires in the theatre of psychoanalytic practice. All this brings us to the new "Self Psychology" of Heinz Kohut. Perhaps more than any other contemporary development, Self Psychology has had the most powerful impact on the previously institutionalized orientations within the psychoanalytic community. Kuhn (1962) has taught us that following a revolution in scientific paradigms, old data are seen in a new light and new discoveries, are included within that vision. In short, the world changes for the scientist after major revolutions in a given discipline. Accordingly, in what follows, I want to take you into Kohut's altered vision of psychoanalysis, with a particular emphasis on his novel discoveries, and the role these played in his revisioning of the clinical relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdoctoral training in primary care health psychology: Duties, observations, and recommendations.

The need for postdoctoral training in health psychology has taken on added importance following transformations of the U.S. health care delivery system toward primary care models of delivery. This transformation provides psychologists with the opportunity to work as primary care practitioners, educators, and researchers, and it suggests the need for postdoctoral training that prepares students for those opportunities. The author addresses issues relevant to postdoctoral training from the perspective of a former participant in a postdoctoral fellowship training program in primary care health psychology. The duties and contributions of a primary care health psychologist are described. These include the provision of graduate medical education and clinical services tailored to primary care. The author also offers recommendations regarding postdoctoral health psychology training in order to enhance psychologists' ability to collaborate with medical professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specific developmental disorders. The language-learning continuum

The goal of this article is to inform and educate those who work with children who present with language-learning disorders about phonologic processing deficits, because this area has been shown to have a significant impact on children and adults who exhibit reading disabilities. Mental health professionals who work with children with reading problems need to be aware of what is known about this source of reading disorders and the implications of this knowledge for prevention and treatment. Advocating for appropriate instruction for children with reading problems is an important role mental health professionals can play in working with this population.     

Limits of perceptual robustness in perspective distortion

Pictures often do not appear distorted even when viewed at oblique angles. Three hypotheses have been put forth to explain this robustness of virtual space toward affine transformations. First, array specificity holds that the perception of depicted space is fully specified by the information available at the point of observation. Second, the notion of a compensatory mechanism involves an unconscious recreation of the scene according to the original viewpoint. Third, the indiscrimination hypothesis denies the ability of the visual system to resolve or detect affine transformations up to a certain degree. Three experiments were conducted to investigate these claims. Using a double projection technique devised by Cutting (1987), Experiment I showed that observers are able to discriminate and compensate, to some degree, for affine transformations if information about the projection surface is available. However, observers relied on relative image velocities rather than reconstructing the object. In Experiment 2 additional observer motion was simulated. In single and double projection trials that required more difficult judgments of object rotation, compensation was poor and observers seemed to rely on local cues. Finally, real and simulated rotation of the projection surface revealed that observers are able to compensate for only one primary projection surface slant. The results reject the indiscrimination hypothesis and support the notion of array specificity.     

Metformin and contrast media--a dangerous combination?

The teaching in medical history at the University of Oslo, Norway, is given as an integrated part of the student training for practical work in health care and community health. I summarize here the underlying argumentation and the teaching experiences, concluding that this is felt as an effective way to convey relevant medical historical knowledge and skills to the future doctors.     

An open source approach to creating positive psychological practice: A comment on Wong's Strengths-centered Therapy.

Positive psychology research has attracted the attention of both scholars and clinicians and is being translated into change strategies that could bring about greater well-being and life meaning. These new therapeutic models could be developed and refined in isolation (within one lab or clinic) and then shared with fellow professionals or developed and subjected to examination and modification by mental health colleagues across the world as we create strengths-based therapies that work. The authors examine Wong's (see record 2006-07640-001) Strengths-centered Therapy and advocate for an open source approach to developing positive psychological practice techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personal reflections on reading Sarason's "Community psychology, networks, and Mr. Everyman."

Responds to S. B. Sarason's (see record 1977-06620-001) discussion of the failure of people involved in institutional and community mental health administration to acknowledge social and political realities and to work effectively within the real world. Suggestions are included for observing real world dynamics before initiating changes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)