A Model for Teaching Health Care Professionals the Components of the Family

With the inclusion of the behavioral sciences component in the National Board Examination (1972), many medical schools have revised their curricula to include sociology in the training of the future physician. In dentistry, the behavioral sciences group of the International Association for Dental Research has increased in membership over the past years. In nursing, courses such as sociology, psychology, and anthropology have already been included in the curricula of various schools. However, the tremendous shortage of qualified social scientists who are capable of relating the behavioral sciences to the health care institution makes it difficult to meet the needs of graduate and professional schools everywhere. In view of this problem, this article will present a simple conceptual model that can be used as an organizational device for teaching the components of the family in relation to the health care institution.     

Infant Mental Health: A Model for Service Delivery

A model for the integration of infant mental health services with existing service delivery systems for high-risk infants and families is described. The Infant-Parent Program provides assessment and treatment for infants and families in situations of potential or actual child abuse, neglect, and disorders of attachment or socioemotional functioning. In addition, the program has established a collaborative network with pediatric care, child protective services, and community agencies serving infants and families at risk. The methods of assessment and treatment and the interface with other child services are described.     

医疗数据整合模式的研究

HL7是涉及到许多不同领域的医疗数据交换标准。通过对该标准的分析,本研究从最底层的结构入手,提出一种进行HL7完整构造的通用方法,并通过软件算法完全实现了此方法。本方法将XML对象树与数据表结合;它不同于其它文献所提的只针对HL7某一特定点或层次的方法,它不仅包含HL7的横向全部消息也深入了HL7的纵向所有层次。另外在此基础上,还提出了一个包含HL7适配器和HL7网关的,适合于不同医疗系统的信息整合模型。     

Modernization of Native Healers: Implications for Health Care Delivery in Ghana

There are two major categories of traditional healers in contemporary Ghana. The traditionalists still adhere to the basic concepts and methods of traditional healing. A significant proportion of healers have, however, adopted a new approach to healing. These new-style healers are rejecting some of the traditional beliefs about etiology of illness, and are reorganizing their medical practice. They have more education, live in cities, and acquire “modern” medical knowledge through formal training at Traditional Medical Training Centers. This new development has had a significant impact on the contributions of traditional medicine in health care delivery in Ghana.     

Cultural Competence and Quality of Care: Issues for Mental Health Service Delivery in Managed Care

Models of mental health service delivery in managed care have evolved without considering the needs of ethnic minorities in any systematic manner. Consequently, these new systems may pose additional barriers to access and treatment. In this article, the impact of the health care crisis on mental health service delivery to ethnic minorities in terms of access, cost, and quality of care issues in managed care systems is explored. A quality-of-care framework is used for addressing the notion of cultural competence as a critical dimension of quality of care for ethnic minority populations. Research in minority mental health and quality of care is integrated in order to explore how various structures, processes, and outcomes in managed care systems (e.g., cost containment structures for controlling the supply and demand of mental health services, utilization management and gatekeeping processes) may impact mental health service delivery to ethnic minorities. Cultural competence is conceptualized as a critical component of quality care for ethnic minority populations.     

Expectations Among Patients and Health Professionals Regarding Web-Based Interventions for Depression in Primary Care: A Qualitative Study

BackgroundOne-quarter of the world’s population will suffer from depression symptoms at some point in their lives. Mental health services in developed countries are overburdened. Therefore, cost-effective interventions that provide mental health care solutions such as Web-based psychotherapy programs have been proposed.ObjectiveThe intent of the study was to identify expectations regarding Web-based psychotherapy for the treatment of depression in primary care among patients and health professionals that might facilitate or hinder its effects.MethodsThe expectations of untreated patients and health professionals were examined by means of interviews and focus groups. There were 43 participants (20 patients with mild and moderate levels of depression, 11 primary care physicians, and 12 managers; 22 of them for interviews and 21 for groups). A thematic content analysis from the grounded theory for interviews, and an analysis of the discursive positions of participants based on the sociological model for groups were performed. Interpretations were achieved by agreement between three independent analysts.ResultsAll participants showed a good general acceptance of Web-based psychotherapy, appreciating possible advantages and improvements. Patients, physicians, and managers shared the same conceptualization of their expectations, although highlighting different aspects. Patients focused on the need for individualized and personalized interaction, while professionals highlighted the need for the standardization of the program. Physicians were concerned with extra workload, while managers were worried about optimizing cost-effectiveness.ConclusionsExpectations of the different participants can conflict with each other. Finding a balanced position among them is needed if we are to harmoniously implement effective Web-based interventions for depression in routine clinical practice.     

Attitudes of Health Care Professionals towards Female Obese Patients

ObjectiveThe health care setting has been reported to be one main source of weight stigma repeatedly; however, studies comparing different professions have been lacking.Methods682 health care professionals (HCP) of a large German university hospital were asked to fill out a questionnaire on stigmatizing attitudes, perceived causes of obesity, and work-related impact of obesity. Stigmatizing attitudes were assessed on the Fat Phobia Scale (FPS) based on a vignette describing a female obese patient.ResultsOnly 25% graded current health care of obese patients to be ‘good’ or ‘very good’. 63% of all HCPs ‘somewhat’ or ‘strongly’ agreed that it was often difficult to get the resources needed in order to care for obese patients. The mean FPS score was comparable to that in the general public (M = 3.59), while nursing staff showed slightly more positive attitudes compared to physicians and therapists. Higher age, higher BMI, and ascribing personal responsibility for obesity to the individual were associated with a higher level of stigmatizing attitudes. The nursing staff agreed on obesity as an illness to a greater extent while physicians attributed obesity to the individual.ConclusionsIn summary, by making complex models on the causes of obesity known among health care professionals, stigmatizing attitudes might be reduced. Ongoing further education for health care professionals ought to be part of anti-stigma campaigns in the medical field.Key Words: Health care professionals, Obesity, Care, Stigma     

A Reason for Optimism in Rural Mental Health Care: Emerging Solutions and Models of Service Delivery

This invited commentary responds to Jameson and Blank's literature review (2007) and utilizes different source materials, such as personal communications among clinicians and policymakers, Internet-based information, and direct professional experience. An update is provided regarding new graduate programs training clinicians for rural service. In addition, perceived barriers to treatment are challenged, because they are drawn from research results that could be interpreted in different ways, given the cultural heritage of southern and central Appalachian people. Lastly, the efforts of the Veterans Affairs Health Care System to reach rural citizens for mental health treatment are summarized. Some of these federal processes could be replicated at the state level, if sociopolitical and economic factors were more directly addressed. The commentary concludes, from the perspective of a professional providing clinical services in a rural setting, that a more optimistic outlook on the state of rural mental health care may be warranted.     

A Mobile Phone Integrated Health Care Delivery System of Medical Images

With the growing computing capability of mobile phones, a handy mobile controller is developed for accessing the picture archiving and communication system (PACS) to enhance image management for clinicians with nearly no restriction in time and location using various wireless communication modes. The PACS is an integrated system for the distribution and archival of medical images that are acquired by different imaging modalities such as CT (computed tomography) scanners, CR (computed radiography) units, DR (digital radiography) units, US (ultrasonography) scanners, and MR (magnetic resonance) scanners. The mobile controller allows image management of the PACS including display, worklisting, query and retrieval of medical images in DICOM format. In this mobile system, a server program is developed in a PACS Web server which serves as an interface for client programs in the mobile phone and the enterprise PACS for image distribution in hospitals. The application processing is performed on the server side to reduce computational loading in the mobile device. The communication method of mobile phones can be adapted to multiple wireless environments in Hong Kong. This allows greater feasibility to accommodate the rapidly changing communication technology. No complicated computer hardware or software is necessary. Using a mobile phone embedded with the mobile controller client program, this system would serve as a tool for heath care and medical professionals to improve the efficiency of the health care services by speedy delivery of image information. This is particularly important in case of urgent consultation, and it allows health care workers better use of the time for patient care.     

Transforming Health Care Service Delivery and Provider Selection

Commoditization pressures in medicine have risked transforming service provider selection from “survival of the fittest” to “survival of the cheapest.” Quality- and safety-oriented mandates by the Institute of Medicine have led to the creation of a number of data-driven quality-centric initiatives including Pay for Performance and Evidence-Based Medicine. A synergistic approach to creating quantitative accountability in medical service delivery is through the creation of consumer-oriented performance metrics which provide patients with objective data related to individual service provider quality, safety, cost-efficacy, efficiency, and customer service. These performance metrics could in turn be customized to the individual preferences and health care needs of each individual patient, thereby providing an objective methodology for service provider selection while empowering health care consumers.     

Conceptualizing Mental Health Care Utilization Using the Health Belief Model

This article uses the Health Belief Model (HBM; Health Education Monographs , 1974, 2:409) as a framework for explaining what factors might encourage or inhibit an individual from utilizing mental health services. The HBM is a socio-cognitive approach that proposes that people are likely to engage in a given health-related behavior when they believe the problem could have serious consequences for daily living activities, when they believe the intervention will be effective, and when they perceive few barriers to taking action. When applied to mental health utilization, this model provides a structure for developing and evaluating programs designed to increase mental health awareness and appropriate utilization.