The Benchmarking Strategy Has a Role to Play Across Cultures

This article responds to the commentary by Cardemil ( 2015 ) on our original article (Spilka & Dobson, 2015 ), in which we proposed the use of a benchmarking strategy to evaluate culturally adapted and transported treatments. We address Cardemil's assertion that a culturally embedded or bottom‐up approach to the development of models of psychopathology and treatment of disorders is optimal and argue that benchmarking provides an alternative model in which treatments may also be developed in one culture and exported, with appropriate adaptation and evaluation, to another. We discuss the circumstances in which benchmarking is likely to have enhanced benefit and argue that this issue should be addressed with research and evidence as part of the global efforts toward evidence‐based practice.     

Promoting the Internationalization of Evidence‐Based Practice: Benchmarking as a Strategy to Evaluate Culturally Transported Psychological Treatments

In addition to the growing evidence‐based practice movement in psychology, psychological treatments are undergoing increasing adaptation and transportation to other countries and cultures around the world, prompting the need to evaluate treatments in these diverse settings. This article proposes the “benchmarking” strategy as a valuable approach to evaluate the effectiveness of culturally adapted or transported treatments and to promote the internationalization of evidence‐based practice. We first describe the benchmarking concept in clinical research, followed by considerations for the cultural adaptation and transportation of psychological treatments. We then explain how the benchmarking strategy may be used to validate culturally transported and adapted psychological treatments. The article concludes with a discussion of considerations, limitations, and challenges for conducting cross‐cultural benchmarking research.     

Rethinking Communication in the E-health Era

There is substantial epidemiological evidence that widespread adoption of specific behavior changes can significantly improve population health. Yet, health communication efforts, while well intentioned, have often failed to engage people to change behavior within the complex contexts of their lives. `E-health communication', health promotion efforts that are mediated by computers and other digital technologies, may have great potential to promote desired behavior changes through unique features such as mass customization, interactivity and convenience. There is growing initial evidence that e-health communication can improve behavioral outcomes. However, we have much to learn about whether the technical promise of e-health communication will be effective within the social reality of how diverse people communicate and change in the modern world. This article examines current evidence concerning e-health communication and evaluates opportunities for e-health applications.     

Clinical utility of cognitive‐behavioural treatment for panic disorder. results obtained in different settings: a research centre and a public mental health care unit

Cognitive‐Behavioural programmes have become the treatment of choice for Panic Disorder (PD). However, although its effectiveness has been widely demonstrated, there are still some limitations regarding the possibility of offering this type of treatment to all panic sufferers. Some researchers are studying ways to make these programmes more available. This study deals with the application and testing of treatment programmes for PD in sites where patients usually look for help for their psychological problems, i.e. mental health care centres. Our work follows a strategy of benchmarking, and the results obtained after applying the treatment in habitual clinical contexts are compared with the results obtained after applying it in research contexts. In the present work, we analyse the possibility of ‘transporting’ a group cognitive‐behavioural programme for PD, developed in a research context, to a more natural setting, a public mental health unit. In this work we present data, using a benchmarking strategy, on one hand, on the differential effectiveness of a group cognitive‐behavioural treatment for PD applied in two different settings: a research setting—a clinical unit at the university; and a natural setting—a public mental health unit. On the other hand, we compare our results with those achieved by other studies carried out in research settings in different countries and a study carried out in a natural setting. Results indicated that our treatment was equally effective in both settings and that effectiveness was comparable to that achieved by the other studies in research and natural settings. Copyright © 2002 John Wiley & Sons, Ltd.     

Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence

BACKGROUND: The provision of health care is inseparable from universal values such as caring, helping and compassion. Consideration for individual values, particularly those of the patient, has also been increasing. However, such consideration is difficult within the context of modern health care, where complex and conflicting values are often in play. This is particularly so when a patient's values seem to be at odds with evidence-based practice or widely shared ethical principles, or when a health professional's personal values may compromise the care provided. SUGGESTED NEW FRAMEWORK: Values-based practice, a framework developed originally in the domain of mental health, maintains that values are pervasive and powerful parameters influencing decisions about health, clinical practice and research, and that their impact is often underestimated. Although it shares starting points with other approaches to values, it suggests that our current approaches lead us to ignore some important manifestations of values at both the general level, as relevant in legal, policy and research contexts, as well as at the individual level, as relevant in clinical practice. Drawing on ideas from philosophy, values-based practice significantly extends the range of phenomena that may be regarded as value-laden. It suggests that one of the reasons for overlooking values is that they are presumed to be shared when not apparently conflicting. Values-based practice is an approach to supporting clinical decision-making, which provides practical skills and tools for eliciting individual values and negotiating these with respect to best available evidence.     

Using Modular Psychotherapy in School Mental Health: Provider Perspectives on Intervention-Setting Fit

The “fit” or appropriateness of well-researched interventions within usual care contexts is among the most commonly cited, but infrequently researched, factors in the successful implementation of new practices. The current study was initiated to address two exploratory research questions: How do clinicians describe their current school mental health service delivery context? and How do clinicians describe the fit between modular psychotherapy and multiple levels of the school mental health service delivery context? Following a year-long training and consultation program in an evidence-based, modular approach to psychotherapy, semistructured qualitative interviews were conducted with 17 school-based mental health providers to evaluate their perspectives on the appropriateness of implementing the approach within a system of school-based health centers. Interviews were transcribed and coded for themes using conventional and directed content analysis. Findings identified key elements of the school mental health context including characteristics of the clinicians, their practices, the school context, and the service recipients. Specific evaluation of intervention-setting appropriateness elicited many comments about both practical and value-based (e.g., cultural considerations) aspects at the clinician and client levels but fewer comments at the school or organizational levels. Results suggest that a modular approach may fit well with the school mental health service context, especially along practical aspects of appropriateness. Future research focused on the development of methods for routinely assessing appropriateness at different stages of the implementation process is recommended.     

Shared decision-making in the context of menopausal health: Where do we stand?

Most health decisions occur in contexts of scientific uncertainty, the “grey zone” of decision-making and many decisions faced by menopausal women are no exception. These contexts are characterized either by scientific evidence that points to a balance between harms and benefits within or between options, or by the absence or insufficiency of scientific evidence: both situations give rise to degrees of uncertainty. Moreover, probabilities of risks and benefits in a population cannot be directly attributed at the individual level, and so uncertainty inevitably exists when considering individual decisions. Consequently, both clinicians and menopausal women need help in resolving uncertainty when facing clinical decisions. In other words, we argue that the ideal model for making decisions in the context of scientific uncertainty is the sharing of decisions between a clinician and a patient, a process known as shared decision-making (SDM). The objectives of this paper are to: (1) review the theoretical basis underlying effective interventions for SDM to occur in the context of menopausal health; (2) present the evidence regarding existing decision support interventions for menopausal women; and (3) identify implications for clinicians, health professional educators and researchers.     

Web-Assisted Tobacco Interventions: Empowering Change in the Global Fight for the Public’s (e)Health

Tobacco control in the 21^st century faces many of the same challenges as in the past, but in different contexts, settings and enabled by powerful new tools including those delivered by information and communication technologies via computer, videocasts, and mobile handsets to the world. Building on the power of electronic networks, Web-assisted tobacco interventions (WATI) provide a vehicle for delivering tobacco prevention, cessation, social support and training opportunities on-demand and direct to practitioners and the public alike. The Framework Convention on Tobacco Control, the world’s first global public health treaty, requires that all nations develop comprehensive tobacco control strategies that include provision of health promotion information, population interventions, and decision-support services. WATI research and development has evolved to provide examples of how eHealth can address all of these needs and provide exemplars for other areas of public health to follow. This paper discusses the role of WATI in supporting tobacco control and introduces a special issue of the Journal of Medical Internet Research that broadens the evidence base and provides illustrations of how new technologies can support health promotion and population health overall, empowering change and ushering in a new era of public eHealth.     

Role of exposure analysis in solving the mystery of Balkan endemic nephropathy

We evaluated the role of exposure analysis in assessing whether ochratoxin A aristolochic acid are the agents responsible for causing Balkan endemic nephropathy. We constructed a framework for exposure analysis using the lessons learned from the study of endemic goiter within the context of an accepted general model. We used this framework to develop an exposure analysis model for Balkan endemic nephropathy, evaluated previous findings from the literature on ochratoxin A and aristolochic acid in the context of this model, discussed the strength of evidence for each, and proposed approaches to address critical outstanding questions. The pathway for exposure to ochratoxin A is well defined and there is evidence that humans have ingested ochratoxin A. Factors causing differential exposure to ochratoxin A and how ochratoxin A is implicated in Balkan endemic nephropathy are not defined. Although there is evidence of human exposure to aristolochic acid and that its effects are consistent with Balkan endemic nephropathy, a pathway for exposure to aristolochic acid has been suggested but not demonstrated. Factors causing differential exposure to aristolochic acid are not known. Exposure analysis results suggest that neither ochratoxin A nor aristolochic acid can be firmly linked to Balkan endemic nephropathy. However, this approach suggests future research directions that could provide critical evidence on exposure, which when linked with findings from the health sciences, may be able to demonstrate the cause of this disease and provide a basis for effective public health intervention strategies. One of the key unknowns for both agents is how differential exposure can occur.     

Making 'Context' concrete: a dialogical approach to the society-health relation

To understand the role of context in constituting health is recognized as a key challenge facing contemporary health psychology. However, few models or theories are available which pinpoint the processes linking individual health with community or societal contexts. This article draws on dialogical and sociocultural psychological theory, to make context concrete by proposing the concepts of 'mediating moments' and 'reflected mediating moments'. These concepts are further developed through their application to the empirical case of the constitution of condom use in sex-worker-client interactions in Calcutta. Interviews and group discussions with sex workers and other 'red light area' residents are interpreted to examine at what moments the societal phenomena of poverty and gender relations come to mediate condom use behaviour.     

Effects of reward context on feedback processing as indexed by time‐frequency analysis

The role of reward context has been investigated as an important factor in feedback processing. Previous work has demonstrated that the amplitude of the feedback negativity (FN) depends on the value of the outcome relative to the range of possible outcomes in a given context, not the objective value of the outcome. However, some research has shown that the FN does not scale with loss magnitude in loss‐only contexts, suggesting that some contexts do not show a pattern of context dependence. Methodologically, time‐frequency decomposition techniques have proven useful for isolating time‐domain ERP activity as separable processes indexed in delta (< 3 Hz) and theta (3–7 Hz). Thus, the current study assessed the role of context in a modified gambling feedback task using time‐frequency analysis to better isolate the underlying processes. Results revealed that theta was more context dependent and reflected a binary evaluation of bad versus good outcomes in the gain and even contexts. Delta was more context independent: good outcomes scaled linearly with reward magnitude and good‐bad differences scaled with context valence. Our findings reveal that theta and delta are differentially sensitive to context and that context valence may play a critical role in determining how the brain processes feedback.     

Airway dysfunction in elite athletes – an occupational lung disease?

Airway dysfunction is prevalent in elite endurance athletes and when left untreated may impact upon both health and performance. There is now concern that the intensity of hyperpnoea necessitated by exercise at an elite level may be detrimental for an athlete's respiratory health. This article addresses the evidence of causality in this context with the aim of specifically addressing whether airway dysfunction in elite athletes should be classified as an occupational lung disease. The approach used highlights a number of concerns and facilitates recommendations to ensure airway health is maintained and optimized in this population. We conclude that elite athletes should receive the same considerations for their airway health as others with potential and relevant occupational exposures.     

Psychoanalytic Psychotherapy in Contemporary Mental Health Services: Current Evidence,Future Role and Challenges

Three interacting challenges are facing all aspects of health care in the United Kingdom: financial restraint in the context of a global economic downturn; a move to services being commissioned and decommissioned by primary care Clinical Commissioning Groups; and a need to provide evidence based practice through ‘payment by results’. Psychoanalytic psychotherapy faces more difficulty than most services in mental health, with long and frequent criticisms of it being expensive and under‐researched; and it is not as well understood by GPs as cognitive behavioural therapy, with which it is frequently unfavourably compared. This review provides an overview of the existing evidence for psychoanalytic psychotherapy, identifying strengths and areas that are under explored. We also argue that psychoanalytic psychotherapy has a unique clinical role but this will need to be clearly stated in the future, and promoted by clinicians to encourage future commissioning in the UK.     

Gender differences in health care provider-patient communication: are they due to style,stereotypes, or accommodation?

This article examines gender differences in health care provider-patient communication within the framework of an ecological model of communication in the medical encounter. The ecological perspective posits that, although health care provider-patient interactions are situated within a number of contexts (e.g. organizational, political, cultural), the interpersonal domain is the primary context within which these interactions unfold. Hence, gender may influence provider-patient interaction to the extent that it can be linked to the interactants' goals, skills, perceptions, emotions, and the way the participants adapt to their partner's communication. The evidence reviewed in this essay indicates that gender differences in medical encounters may come from several sources including differences in men's and women's communicative styles, perceptions of their partners, and in the way they accommodate their partner's behavior during the interaction. However, because gender is but one of many personal and partner variables (e.g. age, ethnicity, personal experiences) that can influence these processes, gender differences are often quite modest (if apparent at all) when examined across a population of health care providers and patients. Implications for future research and communicative skill training are discussed.     

Aiding Universal Health Coverage through Humanitarian Outreach Services and Global Health Diplomacy in Resource-Poor Settings

According to the Lancet Commission Report on Global Surgery, it was estimated that in 2010 about 16.9 million lives were lost due to the unavailability of Surgical services. It was further calculated that 77.2 million DALYs could simply have been averted by providing basic surgical inspection and triage. Aiding Universal Health Coverage (UHC) through Humanitarian Outreach Services in Resource-Poor Settings is both challenging and difficult to execute. However, to promote and ensure the right to health even by vulnerable groups, the role of global health diplomacy (GHD) and humanitarian diplomacy is pivotal. GHD advances the health of the poor, contribute peacekeeping and promote health security as it is also concerned with the design, and delivery of global health interventions and programs in accordance with diplomatic criteria. The synergistic Humanitarian diplomacy is more focused in persuading decision-makers and opinion leaders to act, at all times, in the interest of vulnerable people and with full respect for our fundamental principles. Since the inclusion of surgical care in the universal basic health care services play a critical role in addressing the rising epidemic of injuries, non-communicable diseases and improving quality of life, there is a great need to address the inequities in pediatric surgical services in resource-poor settings. Hence the successful practice of GHD and humanitarian diplomacy is indispensable for establishing global partnerships, securing funding and strengthening systems to promote cost-effective and essential surgical care to achieve UHC and economic development.     

Context in action: implications for the study of children and adolescents

Action theories acknowledge the reciprocal nature of the relationship between individual action and social context. In this article, the author discusses various ways that the social context and the individual's actions can interact in childhood and adolescence. From an ecological perspective, emphasis is placed on two main issues: Children and adolescents develop within an interactive web of social contexts, and the examination of some contexts without taking into account others can lead to an incomplete and inaccurate accounting of the role of the social environment. Social contexts are frequently dynamic systems that fluctuate over time, and the extent to which children and adolescents can exert effortful control over changes in contexts varies. Implications of the ecological perspective for action-oriented research are discussed.     

Factors affecting breast milk composition and potential consequences for development of the allergic phenotype

There is conflicting evidence on the protective role of breastfeeding in relation to allergic sensitization and disease. The factors in breast milk which influence these processes are still unclear and under investigation. We know that colostrum and breast milk contain a variety of molecules which can influence immune responses in the gut‐associated lymphoid tissue of a neonate. This review summarizes the evidence that variations in colostrum and breast milk composition can influence allergic outcomes in the infant, and the evidence that maternal and environmental factors can modify milk composition. Taken together, the data presented support the possibility that maternal dietary interventions may be an effective way to promote infant health through modification of breast milk composition.     

Health care professional support for self-care management in chronic illness: insights from diabetes research

While it has long been recognized that health care professionals play an important role in supporting self-care management in chronic illness, the nature of that support is not well understood. This paper represents an analysis of findings drawn from qualitative research into the development of self-care decision-making expertise in adults with longstanding Type I diabetes, specifically addressing ways in which health professionals' interactions support or fail to support such processes. These findings highlight issues associated with the disease trajectory, the assumptions about intended outcome, and the complex contexts in which individuals live with chronic disease, illustrating the manner in which varying kinds of support may be required at different points within the learning process. They further challenge notions of standardized communication and informational strategies, demonstrating the complexities inherent in the support needs of chronically ill persons as they change over time and context.     

Issues for a Psychology of Men's Health

This article argues for a gendered psychology of men's health. We argue that capitalism and patriarchy, through their reliance on a restrictive definition of masculinity, limit men's choices and impact on their health. A psychology of men's health situates men in their social, cultural and political contexts, addressing the social construction of masculinities and the effects of beliefs about appropriate behaviour on men's health. At the individual level, gender roles can explain men's reluctance to seek help; avoidance of emotional expression; unsafe sexual behaviours; and risk-taking including drug use, crime and dangerous sports. At a social level, identification of the self with paid work, and avoidance of family activities, are problematic. Dominant social discourses position these as freely chosen behaviours, implicitly blaming individual men for risky or antisocial choices; there is little awareness of the role of social constructions in men's choices. A gendered psychology of men's health uses of a variety of epistemologies, focuses on health in its broadest sense, considers the context and is sensitive to cultural diversity.     

Now that we all know that primary prevention in mental health is great,what is it?

This article reviews recent evidence documenting the efficacy of primary prevention approaches in mental health and calls attention to several different ways in which that concept has been used: a) the current, widely espoused, risk detection‐disorder prevention model, pivoting around initial identification of risk factors for adverse psychological outcomes; and b) a more inclusive, challenging, life‐span‐oriented wellness enhancement model, based on the view that psychological wellness per se may provide significant protection against the likelihood of major psychological disorder. The author considers points of overlap between these two models as well as important differences in their underlying conceptualizations, defining strategies, and contexts of support. The article depicts a disorder prevention approach as one aspect of a more comprehensive, life‐span oriented, wellness enhancement approach, and argues for more central roles and support for both models within a changing overall mental health matrix. © 2000 John Wiley & Sons, Inc.