Circumstances of substance use by street youth in Egypt support the case for intervening to prevent adverse childhood experiences

Background: Egyptian street youth use substances including tobacco, illicit drugs, and pharmaceutical drugs. To understand the circumstances, including adverse childhood experiences, that place adolescents at risk for engaging in substance use, we conducted in-depth interviews among a sample of Egyptian street children. Methods: From youth residing at or attending Caritas, a non-profit organization, which provides shelter and education to street youth, seven girls and twelve boys, aged 12–18 years, participated in open-ended, in-depth interviews. Results: Eight out of the 19 participants reported family history (early exposure) to substance use; and seven of them were initiated by either a family member (sibling), friend or coworker. Most of the participants reported a history of conflict with or abuse (verbal or physical) by their parents or siblings, or stressful situations at home; they used substance(s) to alleviate their stress. Few attended school, and some were forced to work and help their family. Conclusions: Among Egyptian youth, adverse childhood experiences, such as poverty, child abuse, and family substance use, challenge somewhat susceptible youths and lead them to the path of substance use and addiction. Prevention intervention should be multifaceted, culturally adaptable, and primarily targeting the social environment during childhood.     

Developing policy in the provision of parenting programmes: integrating a review of reviews with the perspectives of both parents and professionals

Background   Parenting programmes are a key component of the delivery of children's services, but evidence-based policy has often proved difficult to implement.
Methods   The present review addressed this issue by integrating a review of systematic reviews of parenting programmes and a series of focus groups with parents and professionals involved in parenting across three agencies in a regional area (health, education and social work). The review summarizes parenting interventions targeting infant mental health, emotional and behavioural difficulties, autism spectrum disorder and attention deficit hyperactivity disorder, abuse/neglect, alcohol/substance abuse and 'vulnerable' parents. The focus groups discussed topics such as the range of parenting services across the three agencies, accessibility, gaps in the service and future directions.
Results and conclusions   Twenty systematic reviews were summarized. These reviews demonstrated that there is a wide range of parenting programmes available that have the potential to benefit families who are affected by problems ranging from emotional and behavioural difficulties to adolescent substance abuse. However, the findings of the focus groups reveal that the success of these programmes will depend in part on how they can be tailored to meet the social context of the families targeted. These integrated findings are discussed in terms of their implications for policy and practice.     

Communication skills training for medical students: an integrated approach

Skills of communication are not easily taught to medical students. Three main clinical departments (general practice, medicine and mental health) of the Medical Faculty of the Queen's University, Belfast, introduced an integrated course in January 1988 to teach the basic principles. The course is held at the beginning of clinical training and is an integral part of the introductory clinical course. It was introduced in response to the Report of a Working Party of the Education Committee of the General Medical Council (1987) which advocated the need for improved training in history-taking and communication. It is a 12-week course and every Monday and Friday afternoon from 1400 to 1700 hours 12 students are seconded from ward work, four to the Department of Medicine, four to the Department of General Practice and four to the Department of Mental Health. Hand-outs about information to be obtained and interview style are standardized and the principles to be followed are clearly defined in an aide-mémoire. Staff from the Departments of General Practice and Mental Health experienced in teaching communication by videotape feedback and analysis of consultations prepared 12 tutors for their role and responsibilities. Procedures to be followed were carefully explained to all students beforehand. General practice and psychiatry traditionally have established teaching programmes in communication but the inclusion of the Department of Medicine has made a significant impact. Students have come to realize that the taking of a good history demands as much skill as the physical examination of the patient and is an important aspect of any clinical assessment.     

Physiological and Psychological Effects of Delivering Medical News Using a Simulated Physician–Patient Scenario

We examined the acute stress response associated with having to deliver either bad or good medical news using a simulated physician–patient scenario. Twenty-five healthy medical students were randomly assigned to a bad medical news (BN), a good medical news (GN), or a control group that read magazines during the session. Self-report measures were obtained before and after the task. Blood pressure and heart rate were measured throughout the task period. Four blood samples were obtained across the task period. The BN and GN tasks produced significant increases in self-reported distress and cardiovascular responses compared with the control group. There was also a significant increase in natural killer cell function 10 min into the task in the BN group compared with the control group. The BN task was also somewhat more stressful than the GN task, as shown by the self-report and cardiovascular data. These findings suggest that a simulated physician–patient scenario produces an acute stress response in the physician, with the delivery of bad medical news more stressful than the delivery of good medical news.     

非言语型学习障碍儿童社会信息加工的特点

目的: 探讨非言语型学习障碍儿童社会信息加工特点.方法: 本研究为病例对照研究.根据确定学习障碍儿童的标准,先确定学习障碍儿童,然后对学习障碍儿童进行韦氏儿童智力测验,根据测验结果把学习障碍儿童进一步分为非言语型学习障碍组(23人)、言语型学习障碍组(28人),然后按1:1比例选取对照组(51人).设置儿童与同伴、成人相互作用的三类情景,每类情景又分为模糊和清晰两种情况,对三组儿童进行结构性访谈.结果: ①清晰权威情景下.非言语型学习障碍儿童的编码数显著低于对照组儿童[(2.35±1.15)vs.(3.25±1.27),P＜0.01];对人物意图的判断,非言语型学习障碍儿童选择"恶意"的比率(65%)高于言语型学习障碍儿童(29%)(P＜0.05);在工具效能感上,非言语型学习障碍儿童选择有效的比率(74%)高于言语型学习障碍儿童(36%)(P＜0.05).②非言语型学习障儿童在每个情景故事下的总反应数都显著低于对照组儿童[模糊同伴加入情景:(1.17±0.49)vs.(1.09±0.86).P＜0.01;清晰同伴加入情景:(1.09±0.28)vs.(1.69±0.96),P＜0.01;模糊同伴激惹情景:(1.09±0.41)V8.(1.49±0.78),P＜0.05;清晰同伴激惹情景:(1.17±0.49)vs.(1.65±0.95),P＜0.05:模糊权威情景:(0.96±0.36)vs.(1.37±0.72),P＜0.01;清晰权威情景:(1.00±0.30)vs.(1.37±0.59),P＜0.01].结论: ①清晰权威情景下,非言语型学习障碍儿童编码精确性不如对照组儿童;对他人意图的判断非言语型学习障碍儿童比言语型学习障碍儿童倾向于敌意归因;非言语型学习障碍儿童比言语型学习障碍儿童工具效能感高.②在每个情景下,非言语型学习障碍儿童比对照组儿童生成策略少,反应不灵活.     

成都市家庭医生服务现状的定性研究

目的 本研究针对成都市基层医疗卫生服务机构,调查分析了家庭医生服务开展现况、存在的问题,以及家医服务平台的建设情况并提出了改进建议。方法 本研究共抽取了成都市六个基层社区卫生服务机构,对每家机构的1名管理人员和1个家庭医生团队分别进行深入访谈和专题小组访谈,调查时间为2020年12月—2021年2月。结果 成都市双向转诊取得一定成效,但下转难情况依然突出;有偿签约效果不好,居民就诊观念需转变;基层卫生技术人员不足,家医服务增加了日常工作量;家医信息化平台存在诸多问题,功能亟需改善;家医的绩效考核制度有一定激励作用,但仍需完善;基层卫生投入不足,家医政策落地难。结论 规范分级诊疗秩序,畅通双向转诊通道;加强官方媒体宣传力度,转变居民就诊观念;提升基层职业吸引力,培养优质人才;加强信息化建设,完善家庭医生信息化服务平台;健全家庭医生绩效考核制度,调动工作积极性;完善家医配套政策与措施,强化基层机构服务能力。     

Barriers and facilitators to uptake and promotion of influenza vaccination among health care workers in the community in Beijing,China: A qualitative study

BackgroundIn the prevention and control of influenza, it is important for healthcare workers (HCWs) to be vaccinated and recommend influenza vaccines to their patients. However, there is limited evidence on the factors influencing uptake and promotion of influenza vaccination to patients among HCWs in China.MethodsWe conducted in-depth interviews among HCWs in community health centers, including general practitioners (GPs) and preventive health workers (PHWs), during January to February 2017. A total of 21 individuals, purposively selected from six community health centers covering central districts and remote suburbs in Beijing, were interviewed using semi-structured topic guides. Thematic analysis was used to analyze the interviews and coding framework was developed both inductively and deductively.ResultsIdentified factors influencing influenza vaccine uptake included knowledge, perception and recognition, and prior experience of vaccine uptake. All PHWs conservatively recommended influenza vaccine because of concerns about potential patient–doctor disputes. GPs rarely recommended vaccination under their own initiative because vaccine promotion was not their duties. Notably, we found that the division of work was an underlying reason for the different behaviors regarding vaccine uptake and promotion between GPs and PHWs.ConclusionsOur findings highlighted a combination of misconceptions and cognitive biases limiting influenza vaccine uptake among HCWs in China. Our findings indicate that promotion of health education regarding influenza vaccination should be implemented among HCWs. Importantly, the division of work greatly affects the behaviors of HCWs. GPs, who are at the front line in the doctor–patient relationship, have a critical role in influenza vaccination programs.     

A Review of Studies Comparing Checklist and Interview Methods of Data Collection in Life Event Research

Abstract

This article is concerned with the relative merits of checklists and interviews as techniques for collecting data in the study of life events. It presents a detailed review of studies that have directly compared checklists and interviews. The author's conclusion is that the two techniques should not be seen as equivalent in the assessment of life events. Virtually all of the studies reviewed showed a marked tendency to overreport on checklists. The method appears inadequate in distinguishing truly stressful events from trivial occurrences. In contrast, the in-depth interview is sensitive to the subtleties of life events and should be the preferred method when data of any precision and accuracy are required in an empirical study.