L’espace de la santé mentale : un paysage discursif et clinique en remaniement

Objectives

This paper introduces some epistemology about mental health developments and how it leads to reconsider the landscape of clinical practices.

A price to pay: The impact of user charges in ashanti-akim district,Ghana

In present constrained economic circumstances, many governments have introduced or increased user charges for health services. This has been advocated by the World Bank, justified by reference to the raising of revenue, efficiency and, controversially, even the promotion of equity. This paper examines the impact of user charges on utilisation in the Ashanti-Akim district of Ghana since the introduction of charges in 1985. In many ways, user charges have been a success: in recovering fees and maintaining urban utilisation. However some advantages have not materialised because the health infrastructure has not changed adequately. More importantly, equity and affordability have been problematical. For some of the population, services are no longer affordable.     

Secretory immunoglobulin‐A reactivity following increases in workload intensity using the Defined Intensity Stressor Simulation (DISS)

Previous work suggests that secretory immunoglobulin‐A (S‐IgA) reactivity is inversely related to the perceived demands of the stressor. The Defined Intensity Stressor Simulation (DISS) comprises eight stressor modules, and allows for the manipulation of stress either through increasing the number of modules, or increasing the workload of the modules. The current study assessed the effect of increasing the workload of four modules upon S‐IgA reactivity and perceived demands. Participants (N = 14) attended three sessions on consecutive days where they provided a timed saliva sample immediately before and after 5 min on the DISS at low, medium and high workload. Following each session participants recorded their perceptions of the task with regard to workload and levels of stress and arousal. Perceived workload and stress, but not arousal, increased in accordance with increases in workload, however, differential S‐IgA reactivity was observed. Low workload resulted in a slight increase in S‐IgA secretion; medium workload elicited significant up‐regulation, while down‐regulation of S‐IgA occurred following high workload. As DISS is analogous to a variety of working environments it is suggested that the observed S‐IgA reactivity is indicative of how individuals react to multi‐tasking environments when faced with increases in objective or perceived workload demands. As S‐IgA levels are related to protection from illness, down‐regulation of S‐IgA in those who perceive greater demands may lead to greater vulnerability to ill‐health. Copyright © 2005 John Wiley & Sons, Ltd.     

Personal relationships with an intelligent interactive telephone health behavior advisor system: a multimethod study using surveys and ethnographic interviews

The burgeoning of consumer health informatics and virtual health care can help people improve their health. However, little is known about individuals' reactions to such systems. We conducted an evaluation of the telephone-linked care (TLC) system, a computer-based telecommunications system, that functions as an at home monitor, educator, and counselor for patients with chronic health conditions. Our multimethod assessment of individuals' reactions to using TLC included both quantitative and qualitative methods. Ethnographic in-depth open-ended interviews indicated more subtle and surprising reactions to TLC than the overall positive responses from surveys: individuals formed personal relationships with this technology. This relationship formation suggests that TLC designers may have been successful in their attempts to emulate a conversation with a human being. Our study adds to evidence that technology can serve as a projective device for peoples' values and psychological issues. Both designers and users project values and goals onto computer-based technologies and take on different identities through it. Different groups of users, therefore, may see the same technology differently. People also form relationships with technologies, as they did with TLC. These findings, as well as implications for system design and health outcomes, need to be explored in additional studies.     

农村基层卫生单位对卫生技术人才评价及对基层卫生人才素质要求调查

目的：了解农村基层卫生单位对不同层次卫生技术人才评价和对卫生技术人才的素质要求。方法：对120名乡镇卫生院院长或卫生管理人员进行问卷调查。结果：中心乡卫生院院长对本科学历的医疗专业人员的满意率高于普通乡,中心乡和普通乡卫生院院长对具有专科学历的医疗人员的满意率均较高,满意率分别为72．09％,94．59％;乡镇卫生院需求甘愿献身农村卫生事业具有医学专科学历的大夫和具有正规学历的护理,药剂,医护人员,结论：调整医学教育方向,充分利用高,中等医学院校培养符合农村需求的卫生技术人才。     

With how many users should you test a medical infusion pump? Sampling strategies for usability tests on high-risk systems

Usability testing is recognized as an effective means to improve the usability of medical devices and prevent harm for patients and users. Effectiveness of problem discovery in usability testing strongly depends on size and representativeness of the sample. We introduce the late control strategy, which is to continuously monitor effectiveness of a study towards a preset target.A statistical model, the LNB_zt model, is presented, supporting the late control strategy. We report on a case study, where a prototype medical infusion pump underwent a usability test with 34 users. On the data obtained in this study, the LNB_zt model is evaluated and compared against earlier prediction models.The LNB_zt model fits the data much better than previously suggested approaches and improves prediction. We measure the effectiveness of problem identification, and observe that it is lower than is suggested by much of the literature. Larger sample sizes seem to be in order. In addition, the testing process showed high levels of uncertainty and volatility at small to moderate sample sizes, partly due to users’ individual differences. In reaction, we propose the idiosyncrasy score as a means to obtain representative samples. Statistical programs are provided to assist practitioners and researchers in applying the late control strategy.     

某二级综合医院女职工孕期劳动保护需求情况调查

目的:了解上海市某二级甲等综合医院女职工孕期劳动保护需求情况。方法:便利抽取上海市某二级甲等综合医院的392名女职工,运用女职工孕期劳动保护需求调查表进行问卷调查。结果:孕期休长假需求情况:23.1%的女职工认为怀孕后需全程休假,61.4%的女职工认为需根据身体及岗位而定;孕期工间休息需求情况:87.4%的女职工认为怀孕后需全程安排工间休息,且希望孕早、中期工间休息的时间为30分钟,7个月后工间休息的时间为60分钟;生育后岗位安排:83.4%的女职工希望生育后回原岗位。不同职业、科室及是否准备生二胎情况的女职工其孕期全程休假需求率比较差异有统计学意义(P0.05),职业为护士、科室为病房、准备生二胎的女职工孕期休长假需求较高。结论:医院相关部门应做好女职工孕期劳动保护工作,在保障女职工休息、休假及生育待遇方面权利的同时,采取合理措施,通过人性化排班制度,提供多元化的岗位选择及加强工间休息等举措来调动女职工的工作积极性,降低女职工孕期全程休假事件的发生率,以有效利用有限的人力资源。