The mental health needs of physically disabled persons: Their perspective.

Evaluated disabled persons' perceptions of the types of problems experienced by the disabled population and the extent of this population's need for psychological services. 145 severely physically disabled former clients of a state rehabilitation commission responded to a questionnaire. Data show that 55% of Ss were aged 16–29 yrs, while 88% were 55 yrs old or less. 61.3% of Ss were males; 41% of Ss were married, 13% were divorced, 8% were separated, and 36% were single. 75% reported substantial need; 8% felt there was minimal or no need. Perceived problem areas included personal/emotional, organic/biological, marital/family, and vocational/career planning. Results suggest that this group of consumers perceives that there is a significant need for mental health services among individuals who are physically disabled. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social work practice in health care: looking to the future with a different lens

Social work practice in health care must change to better meet the needs of individuals and their families as the system of care changes from an acute care focus to a community based focus and as individuals seek more active participation in their own care decisions. Practitioners and educators must renew their partnership to create a practice based on the needs of individuals to move most effectively through a more complex system of care and back home again. A paradigmatic shift can redefine social work in health care for the future. Renewed leadership with vision is required.     

Social work roles in America''s changing health care

The development of the human lateral vestibular nucleus was studied on serial sections of the brain of 8 fetuses and neonates at 12-40 weeks of gestation, an infant at 2 months of age and an adult of 63 years using a microscope with a drawing tube and an image-analysing computer system. A morphometric analysis revealed that the lateral vestibular nucleus, whose neurons were distinguished from glia after 16 weeks of gestation, divided cytoarchitectonically into the medial and the lateral subnuclei at 21 weeks of gestation onwards, and showed the moderate development in terms of the columnar length and volume, neuronal size and neuropil.     

Ethics in reproductive health care: a midwifery perspective

To monitor personal exposure to biologically effective solar-UV radiation, Bacillus subtilis spores on a membrane filter and UV-coloring labels were incorporated into a monitoring badge. The samples were covered with one of three types of filter sheet, dependent on the season, to reduce the amounts of exposure to measurable levels. Five fifth- or sixth-grade classes of primary schools, each consisting of 30-40 children, were chosen in northern (Sapporo), central (Tsukuba and Tokyo), and southern (Miyazaki and Naha) cities in Japan. In all four season, each child wore a badge on an upper arm for the entire waking hours, changing it daily, for a week. Upon collection of the badges, the survival of spores and the extent of coloration of the label were determined. The results were used to estimate the amount of daily exposure to biologically effective UV radiation, expressed as the value of spore inactivation dose. Unexpectedly, the average amounts of exposure were not directly correlated with the outdoor UV irradiance: in the two southern cities, despite high outdoor irradiance from spring to autumn, the average amounts of exposure were less than 3.1% of the average irradiance. Highly concentrated exposures occurred in two central cities on three days when extensive outdoor exercise took place. These results contradict the simple notion that children's exposure is in proportion to the outdoor UV irradiance, and support the view that the extent of solar-UV exposure is primarily determined by life-style rather than living location.     

Competing ideologies in health care: a personal perspective

With the introduction of general management and then of planned markets into the National Health Service (NHS), health care in the UK has gone through a massive amount of change. The effect on those working for the NHS has been 'challenging' and often confusing. This paper aims to clarify what is happening by taking an ideological perspective: what ideologies exist, how they are changing and the strategies being used to ensure their survival. Ideologies are basically about power. The relationship between market, managerial and professional ideologies is analysed using charters, codes of conduct and other associated documents. A tentative conclusion is reached that professional ideologies are able to adjust to the overriding market/consumerist ideology. However, the managerial ideology is having difficulty in gaining any real ground against the professional ideology and is having to move strategically by using audit, not just of finance, but also of clinical judgement, to gain power.     

Social work in health care: do practitioners' writings suggest an applied social science?

There are two sources of literature in social work-one from academics and the other from practitioners. Each group is driven by different motivations to write. Academics seek a 'scientific rationality' for the field, while practitioners assume practical and intuitive reasoning, experience aligned with theory, and the 'art of practice' to guide them. It has been said that practitioners do not write and that 'faculty' are the trustees of the knowledge base of the profession, and are responsible for its promulgation via publication. Practitioners, however, do write about their practice and their programs, and analyze both, but publish much of their work in non-social work media. Their work tends not to be referenced by academic writers. One department's social workers' publications are described. We learn, from their practice writings, what concerns clinicians. Theirs is case-based learning, theoretically supported, in which the organization of services calls for their participation in multi-professional decision-making. There is the growing realization among social workers that practice wisdom and scientific technologies need to be reassessed together to find ways to enhance social work services. Clinicians' knowledge can lead to continuing refinement of practice and enhanced institutional services. If practitioners' writings can be assessed, they may lead to a written practice knowledge base, subject to timely change. Academic and practitioner separateness hampers progress in the field. They need each other, and a shared professional literature. There is beginning indication they are getting together.     

Health-care utilization by disabled persons: a survey in rural Bangladesh

The purpose of the present study was to examine the utilization of health services by disabled persons in rural Bangladesh and to identify associated factors to inform the development of appropriate health services. Household surveys were conducted in two villages of Bangladesh by a trained primary-care specialist who lived in the study area for 4 months. About 81% of the sample had utilized some form of health care with more than half consulting unqualified practitioners of modern medicine. Disabled persons whose families perceived they were disabled were 14 times more likely than others to seek treatment. Being male and in the economically productive age group, having an acquired disability and having some form of belief about disability causation were associated with utilization. The conclusions of the study are that social and cultural barriers prevent certain groups, notably women and demographically dependent age groups, from accessing health care. Those who are economically beneficial to the family usually utilize health services. A combination of educational and economic initiatives such as a disability benefits allowance would strongly promote the health of disabled persons and create a general awareness of disability in Bangladesh. A long-term programme which includes disability training for health-care workers and use of financial institutions and existing local government infrastructure for intensive rehabilitation will improve quality of life for disabled persons and is proposed for urgent implementation.     

Improving health care delivery for persons with multiple sclerosis

Persons with multiple sclerosis (MS) have a close-to-normal life span and can look forward to a high level of consumption of health care services for an average of 40 to 50 years. As expensive new treatments for MS are developed and better rehabilitation techniques are implemented, lifetime health care costs for MS patients can be very great. This article discusses ways in which these costs can be managed.     

Teleworking in connection with technical aids for disabled persons

An experimental teleworking arrangement was established between Milan and Rome in order to evaluate the use of multimedia technology and remote working for improving the service provided by an information and advice centre for the disabled. This activity requires a highly interdisciplinary approach and both clinical and technical expertise. The hypothesis was that offering the lone expert in Rome the possibility of teleconsulting with colleagues in Milan (where the whole range of expertise was available) would provide a comprehensive service for disabled clients asking for advice on technical aids in Rome. The results of an experiment demonstrated the feasibility of such teleworking and allowed a teleconsulting method to be defined that fits the specific needs of the technical-aid information service and improves quality.     

Micropsych: Applications in a residential facility for developmentally disabled persons.

Investigated the impact of a microcomputer system that was used to assist a psychologist in the assessment, training, and management of developmentally disabled persons living in a large residential facility. The microcomputer system generated evaluation reports, analyzed behavior patterns, and prepared comprehensive individualized behavioral intervention plans for individuals. These products were used by the psychologist to assist the facility's management with decisions about placement of residents and resource allocation. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supported work: An innovative approach to the vocational rehabilitation of persons who are psychiatrically disabled.

Presents a model for the vocational rehabilitation of persons with severe psychiatric disability (SPD) that helps clients find private-sector jobs and provides support to both client and employer. Preliminary data on a supported work program in which 152 Ss with SPD participated suggest that the model is effective in returning individuals with SPD to competitive employment. Close monitoring of a subset of 34 Ss during the 1st yr of the program revealed that Ss whose disabilities were identified in adolescence (age 19 yrs or younger) were almost twice as likely to be employed as those with an adult onset. Clinical stability and level of motivation also appeared to affect program outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-perceived unmet health care needs of persons enrolled in HIV care

This study investigated the actual growth rate of 30 low stage operable non-small cell lung carcinomas, including disease-free surviving and deceased patients. The actual growth rate was defined as the cell production rate and was calculated from the growth fraction and the cell cycle time of each tumor at the time of surgical resection. The growth fraction was assessed by the Ki67 index while the cell cycle time was assumed to be reflected by the AgNORs content in the cells positive for Ki67. AgNORs content was evaluated by means of image analysis of double-stained AgNOR-Ki67 tissue section. The actual growth rate did not discriminate between the disease-free surviving and deceased patients but the AgNORs content in Ki67 cells correlated with the survival time of those patients who died of the tumor. Patients expressing a small AgNORs content, which might indicate a long cell cycle, may die but later; patients with a high AgNORs content, which might indicate a short cell cycle, die early or will survive. A twilight curve was derived from this data and might provide new prognostic indicators.     

Influencing the rising costs of health care: a staff nurse's perspective

In the current atmosphere of rising health costs and increasing hospital expenditures, nurses must take an active role in seeking solutions to these problems. The staff nurse can positively influence the events that occur when a person is admitted into the hospital and can play a major role in the functioning of the organization as a whole, which in turn affects the larger domains of society.     

Antimalarial work in China: a historical perspective

The effects of dizocilpine maleate (MK-801) on vicarious trial-and-error (VTE), and on simultaneous olfactory discrimination learning and its reversal, were observed in weanling rats. The term VTE was used by Tolman (The determiners of behavior at a choice point. Psychol. Rev. 1938;46:318-336), who described it as conflict-like behavior at a choice-point in simultaneous discrimination learning. It takes the form of head movements from one stimulus to the other, and has recently been proposed by Amsel (Hippocampal function in the rat: cognitive mapping or vicarious trial-and-error? Hippocampus, 1993;3:251-256) as related to hippocampal, nonspatial function during this learning. Weanling male rats received systemic MK-801 either 30 min before the onset of olfactory discrimination training and its reversal, or only before its reversal. The MK-801-treated animals needed significantly more sessions to acquire the discrimination and showed significantly fewer VTEs in the acquisition phase of learning. Impaired reversal learning was shown only when MK-801 was administered during the reversal-learning phase, itself, and not when it was administered throughout both phases.     

Adolescent health care: A public policy perspective.

Focuses on the importance of psychosocial and behavioral components of health care in the area of adolescent health care. The authors contend that it will ultimately be as a direct result of psychology's tangible (and visual) successes in areas such as adolescent health that will lead to psychological services becoming fully accepted within the overall health care system. The underlying policy notion is that if psychology addresses society's perceived needs, society (i.e., the nation's public policy/political leadership) will strive to meet the mental health profession's needs. The majority of problems adolescents face, regardless of apparent physical symptomatology, are essentially behavioral (psychosocial) in nature. The symptom distress model provides for a school-based integration of psychological knowledge with clinical and educational expertise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed mental health care: The client's perspective.

Changes in psychotherapy services have been the focus of controversy between psychologists and the managed-care industry, yet too seldom have client preferences been directly heard in that debate. This study investigated consumer attitudes about the central elements of psychotherapy service delivery by 3 participant groups: self-pay clients, managed-care clients, and adults without therapy experience. Important differences of opinion were found among participant groups, yet results revealed that all 5 elements investigated were considered essential. Autonomy in treatment decision-making was ranked most important, followed by choice of therapist, copayment amount, limits to confidentiality, and ease of access to care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When do health care decisions discriminate against persons with disabilities?

Recent interpretations of laws prohibiting discrimination against persons with disabilities indicate that these laws will play a greater role in health care decision making than previously anticipated. This article employs lessons from other areas of antidiscrimination law to examine these developments and to provide a framework for making health care decisions that are consistent with these new legal interpretations. This article addresses decisions in individual cases, treatment policies adopted by health care providers, and coverage programs of third-party payers, both public and private.