Collecting health information at a local level

Target 35 of the ‘Health for All’ strategy statesthat "member states should have health information systems capableof supporting their national strategies for Health for All". in Rorterdam a local health information system has been developedwhich aims to:

• Monitor the health situation and related factors in the cityof Rotterdam at district and neighbourhood level;
• Contributeto the development of a local health policy for reducingthenoted differences in the health situation of the population.

information is collected from various sources including:

• data on mortality and morbidity and statistics concerning healthrelated areas like housing, employment, traffic, environment,etc.;
• data collected from the population itself;
• ideas andviews of key informants;
• documentary information.

The article outlines the design of the system, gives a reviewof the information stored and presents some of the results.     

Stress, coping, and health: a comparison of Mexican immigrants, Mexican-Americans, and non-Hispanic whites

Mexican immigrants, Mexican-Americans, and non-Hispanic white Americans all face different stressors. Stress-coping strategies may vary for each group as well. We compared relationships among perceived stress, stress-coping strategies, and health-related quality of life (HRQL) in a rural sample of Mexican citizens living in the United States, Mexican-Americans, and non-Hispanic whites. Health-related quality of life and stress-coping styles varied among the three groups. Mexican citizens reported significantly better physical functioning than did non-Hispanic whites or Mexican-Americans. Mexican-Americans reported significantly better mental health functioning than did non-Hispanic whites or Mexican citizens. Mexican citizens were more likely to use positive reframing, denial, and religion, and less likely to use substance abuse and self-distraction, as stress-coping strategies. Stress-coping style may be a potentially modifiable predictor of physical and mental HRQL, and may account for part of the Hispanic health paradox.     

A microeconometric analysis of Canadian health care utilization

Understanding health care utilization is important to design efficient and effective health systems. Toward this end, we develop a relatively simple and intuitively appealing microeconometric framework to analyse health care utilization and illustrate its use with recent Canadian microdata. We find that health care utilization consists of distinct stochastic processes requiring the use of two stochastic regression models. In particular, the latent class modelling framework is the superior statistical framework if the data permit modelling unobserved heterogeneity and overdispersion. In many instances, results differ for the classes of high and low users of health care services.     

复发性流产患者家庭功能及应对方式与心理状况分析

目的：探讨复发性流产（ RSA）患者家庭功能、个人应对方式及心理健康之间的关系。方法选取复发性流产患者及普通妇女各115例作为病例组及对照组,采用家庭功能评定量表、医学应对方式问卷及症状自评量表（ SCL-90）进行调查,分析三者之间的关系。结果与对照组比较,复发性流产患者SCL-90各因子均分及总分较高（均P＜0．05）,家庭功能中的“问题解决”、“沟通”、“角色”、“行为控制”及“总的功能”得分明显较低（t值分别为3．58、2．81、2．45、2．16、2．81,均P＜0．05）,更倾向于采取“屈服”消极应对方式（t＝3．08,P＜0．01）。复发性流产妇女的SCL-90各因子得分与家庭功能各因子得分呈显著正相关（P＜0．05）,家庭功能各因子与个体的消极应对方式“屈服”均呈显著负相关（r值分别为-0．12、-0．12、-0．12、-0．11、-0．14、-0．13、-0．12,均P＜0．05）。多元回归分析表明,夫妻关系及自然流产次数是影响复发性流产患者心理健康状况的主要因素。结论复发性流产患者心理健康状态差,应帮助其建立正确的认知与积极的应对方式,给予主动、持续、个体化的集关爱与综合干预一体的临床诊治,注重家庭整体系统的干预,以提高复发性流产患者的心理健康水平。     

A critical analysis of recent Canadian health policy: models for community-based services

As part of the thrust by Health and Welfare, Canada, to strengthen community health services, the National Health Research and Development Program commissioned a series of literature reviews. I undertook to review organizational models for community-based services, but said that this would be done in the context of the developing organization of the national health insurance program. With the help of colleagues I examined the literature from a number of different viewpoints. This article will present our findings on the development of policy and will trace the difficulties in making a shift towards providing more care in the community. We found that organization theories were helpful for explaining developments in the health service as a whole and the place of community-based services within it. We were able to use these theories to analyse efforts at restructuring. They provide explanations for the concurrent existence of policies of rationalization and cutbacks with policies of expansion in the area of health promotion.     

National opportunities for health promotion: the Canadian experience

Health promotion is a fundamental strategy to address the majorissues which confront health systems in developed and developingcountries alike. Chief amongst these issues are unhealthy environments,health inequities and non-communicable diseases. The infrastructuresfor health promotion include mechan isms for development andimplementation of health policy; policies and programs supportiveof community involvement in health promotion programs; reorientationof the health care system towards prevention; and research.Consensus building among key stakeholders from the public andprivate sectors is at the core of the policy development process.A New Perspective for the Health of Canadians (1974) and theWHO Ottawa Charter for Health Promotion (1987) have guided healthpromotion policy and program development at both the nationaland provincial levels, in Canada, a number of initiatives haveplaced into pra ctice the policy frameworks, among them: HealthyCommunities, the Canadian Heart Health initiative, integrationofpreven lion into clinical practice, and structures to supportresearch in health promotion.     

'Race' matters: racialization and egalitarian discourses involving Aboriginal people in the Canadian health care context

The major purpose of this paper is to examine how 'race' and racialization operate in health care. To do so, we draw upon data from an ethnographic study that examines the complex issues surrounding health care access for Aboriginal people in an urban center in Canada. In our analysis, we strategically locate our critical examination of racialization in the 'tension of difference' between two emerging themes, namely the health care rhetoric of 'treating everyone the same,' and the perception among many Aboriginal patients that they were 'being treated differently' by health care providers because of their identity as Aboriginal people, and because of their low socio-economic status. Contrary to the prevailing discourse of egalitarianism that paints health care and other major institutions as discrimination-free, we argue that 'race' matters in health care as it intersects with other social categories including class, substance use, and history to organize inequitable access to health and health care for marginalized populations. Specifically, we illustrate how the ideological process of racialization can shape the ways that health care providers 'read' and interact with Aboriginal patients, and how some Aboriginal patients avoid seeking health care based on their expectation of being treated differently. We conclude by urging those of us in positions of influence in health care, including doctors and nurses, to critically reflect upon our own positionality and how we might be complicit in perpetuating social inequities by avoiding a critical discussion of racialization.     

Multilevel analysis of income, income inequalities and health in Spain

The aim of this study is to test the influence of personal income (absolute income hypothesis), income inequalities and welfare (relative income hypothesis) on health. A multilevel cross-sectional logit model is used with two alternative specifications of the dependent variable: self-perceived health and chronic illnesses, and six specifications of the income inequality: three positive and three normative. This study incorporates lagged values of the regional variables and interactions between the individual and the regional variables. The data is drawn from the Spanish Life Conditions Survey for 2007 and consists of 28,023 individuals over 16 from 17 autonomous communities. The results support the absolute income hypothesis that a higher level of personal income is correlated with a lower probability of negative health outcomes. The relative income hypothesis results are mixed with only some indicators showing a significant relationship with health. The results also indicate that being a man, being married, working and having a high level of education are related to improved health. This study emphasizes the importance both of the health variable and of the specification of income inequality, and contributes to augmenting the limited empirical evidence available in Spain on the influence of income and income inequalities on the health of the population.     

Equity in health and health care in a decentralised context: evidence from Canada

The impact of administrative decentralisation on equity in health and health care is an important unresolved issue in the health policy debate. Predictions from the limited theoretical literature and the relevant empirical research are both insufficient to draw any firm conclusions. Many countries are nevertheless experimenting with decentralisation policies in the absence of research evidence. This paper presents an exploratory empirical analysis of decentralisation by investigating the spatial dimensions of health-related equity in Canada, a highly decentralised setting. Using data from the 2001 Canadian Community Health Survey, we apply a decomposition method of the Concentration Index to explore whether income-related inequalities in health and inequities in the use of health care are more likely to be due to gaps between rich and poor Canadian provinces rather than to differences between rich and poor individuals within them. The results show that within area variation is the most important source of income-related health inequality, while income-related inequities in health care use are mostly driven by differences between provinces.     

驻岛礁军人心理健康状况与应对方式研究

目的了解驻岛礁部队军人的心理健康状况及应对方式特点。方法采用症状自评量表(SCL-90)和简易应对方式问卷对236名驻岛礁军人进行调查．分析他们的心理健康状况．应对方式特点及其影响因素。结果(1)驻岛礁军人SCL-90各因子分均显著高于地方常模，而且除躯体化因子外，其余各因子分也明显高于军人常模；(2)驻岛礁部队军人在面对应激时，采取积极应对方式较多，消极应对方式较少；(3)他们所采取的积极应对方式与心理健康水平呈显著弱正相关(γ=0．153)，消极应对方式与其心理健康水平呈极显著正相关(γ=0．567)，与抑郁因子相关程度最高(γ=0．569)；(4)进一步的多元逐步回归分析表明，消极应对方式与心理健康有密切关系(R^2=0．318)，尤其是以下4种消极应对方式对他们的心理健康产生较大的消极影响，分别是试图忘记整个事情，通过吸烟喝酒、服药和吃东西来解除烦恼，幻想可能会发生某种奇迹改变现状和接受现实。结论驻岛礁军人心理健康状况明显低于地方人群和军队总体水平，消极应对方式是影响他们心理健康水平的重要因素。     

孤独症儿童家长的应对方式与心理健康的相关性研究

目的探讨孤独症儿童父母的应对方式与心理健康的关系,为孤独症儿童的康复治疗营造更有利的家庭环境。方法使用90项症状清单、应对方式问卷对72例孤独症儿童的父母和64例健康儿童父母进行对照研究。结果研究组"解决问题"的应对方式少于对照组,幻想、退避的应对方式多于对照组,差异有统计学意义。多因素回归分析的结果显示应对方式对SCL-90的总分及各因子均有影响。结论孤独症儿童父母易出现心理健康问题,他们的应对方式会增加出现强迫状态、人际关系敏感、恐怖等精神症状的危险。     

Influence of health promotion bureaucracy on community participation: a Canadian case study

The purpose of this paper is to illustrate, through a Canadian case study, the bureaucratic support and obstacles for community participation in health promotion. The paper begins with a brief history of the development of a participatory health promotion programme in Canada. The role of bureaucracies on participation of communities is highlighted. Secondly, the paper describes how a variety of bureaucratic factors affected grassroots community participation efforts of local projects in one province. Finally, discussion focuses on how community participation is constrained in a bureau-cratically mediated activity such as health promotion.     

教师职业压力、应对方式与心理健康关系

目的 探讨中小学教师职业压力、应对方式及心理健康之间的关系。方法 采用教师职业压力、应对方式与心理健康问卷对参加宁夏回族自治区教师培训班的394名中小学教师进行调查。结果 中小学教师在心理健康水平(F(1,390)=32.765,P<0.001)与职业压力(F(1,390)=4.859,P<0.05)上存在学校的主效应;在心理健康(F(1,390)=22.494,P<0.001)与职业压力(F(1,390)=7.230,P<0.01)上存在学校与性别的交互作用效应;中小学教师职业压力与心理健康、应对方式相关性差异有统计学意义(r₁=0.202,P<0.01;r₂=0.102,P<0.05);教师职业压力、应对方式中的消极应对、工作负荷、职业期望、自我发展需要、考试压力、积极应对6个因子进入心理健康回归方程,且β系数达到显著水平(t=2.068～6.835,P<0.05),6个因子可解释心理健康18.9%的方差变异。结论 中小学教师职业压力与应对方式对其心理健康有影响。     

Management of human resources in health care: the Canadian experience.

Each of Canada's ten provinces has a publicly administered system of health insurance, funded by provincial and federal taxes, that is accessible to all citizens and covers all medically necessary services provided by physicians and hospitals. Canadians spend an estimated 9.2 percent of their gross national product on health care (about 2.8 percentage points below US spending), of which three quarters is public-sector spending. According to the Organization for Economic Cooperation and Development, Canada's health status is equal to or better than that of the United States, despite lower per capita health spending. About seven percent of the Canadian labour force works in health care, and attempts to introduce coordinated planning of human resources in health care have not as yet proceeded far. The predominant policy issue here is the supply and the role of physicians. It has been argued that entrenching within the system the fee-for-service method of paying physicians has created a disincentive to the delegation of responsibility to health personnel other than doctors. It is also argued that introduction of government-run health insurance provided the opportunity for human resource planning, but that the decision by governments to act only as the payer resulted in ad-hoc planning approaches. However, governments' concern over health care costs has led to a more direct role by them in the planning of the human resources in health. They are re-examining the autonomy and jurisdictional rights of the professions that deliver health care to Canadians.     

儿科护士压力应对和社会支持与心理健康的关系

目的：研究儿科护士压力应对方式、社会支持与心理健康的关系,为进行循证团体心理干预寻找理论支持。方法采取分层抽样的方法,使用一般情况调查表、症状自评量表（ SCL-90）、应对方式问卷和社会支持评定量表对福建省福州儿童医院临床科室护士111名进行问卷调查。结果17．82％的儿科护士心理健康筛查阳性,比中国常模高（χ2＝4．36,P＜0．05）。客观支持、主观支持、支持利用度及解决问题型的压力应对方式均与SCL-90总分存在极其显著的负相关（ r值分别为-0．27、-0．38、-0．24、-0．40,均P＜0．01）;自责型及幻想型的压力应对方式与SCL-90总分存在显著的正相关（r＝0．37,P＝0．00;r＝0．26,P＝0．02）;解决问题型应对方式与社会支持三维度均显著正相关（r值分别为0．27、0．44、0．26,均P＜0．01）,求助型应对方式与支持利用度显著正相关（r＝0．32,P＝0．00）,而退避型应对方式与主观支持显示负相关（r＝-0．28,P＝0．02）。结论不同的压力应对方式及社会支持程度与儿科护士的心理健康状况显著相关,尤其是解决问题型应对方式及主观支持水平高的儿科护士,心理健康状况较好。主观支持程度能显著预测儿科护士的心理健康状况。     

导师指导行为与研究生应对及心理健康关系

目的 了解应对方式在导师指导行为和研究生心理健康之间的关系,为提高研究生心理健康水平提供数据支持。方法 采用分层随机相结合的方法,按照全国六大行政区,在全国28所具有研究生培养资格的高校共1 274名在学研究生为调查对象,采用自编研究生对导师指导行为评价问卷、简易应对方式量表（SCSQ）和症状自评量表（SCL-90）进行调查。结果 研究生阶段压力最大事情依次为学习和科研（55.7%）、经济压力（18.0%）、工作选择（15.9%）;39.2%的研究生报告导师有时、经常或总是“根据自己利益决定研究生发表论文的署名”、23.8%的研究生报告“导师将自己的愤怒发泄到研究生身上等,导师指导行为被评价为不合理的频率高时,研究生心理健康水平低（r=0.344,P<0.01）;研究生采用积极应对方式时,心理健康水平高（r=-0.157,P<0.01）;导师指导行为对心理健康的直接效应有统计学意义（β=0.31）,中介变量积极应对对心理健康的预测作用有统计学意义（β=-0.23）,中介效应占总效应的比例为10.82%;消极应对对心理健康的预测作用有统计学意义（β=0.11）,中介效应占总效应的比例为8.09%。结论 应对方式在导师指导行为和研究生心理健康之间起到部分中介作用;提高研究生采用积极应对策略意义重大。     

Rural health research in Canada: at the crossroads

ABSTRACT: Rural health research in Canada is at the crossroads. Jolted by the establishment of the Canadian Institutes of Health Research, rural health researchers are trying hard to overcome past benign neglect and the lack of cohesion and collaboration within the rural health research community. Although there is considerable catching-up to do, rural health research in Canada has a firm foundation. Backed by a growing network of rural health research centres, researchers are searching for ways to work together in order to advance rural health research and the health and wellbeing of rural Canadians.     

监狱女警察心理健康与应对方式关系

目的 探讨监狱女警察(简称女警)心理健康与应对方式的关系.方法 采用症状自评量表(SCL-90)和应对方式问卷对128名监狱女警进行调查.结果 监狱女警躯体化(1.68±0.04)、强迫症状(1.91±0.05)、抑郁(1.77±0.05)、焦虑(1.60±0.04)、敌对(1.68±0.05)、恐怖(1.32±0.02)、精神病性(1.47±0.03)和其他(1.76±0.05)得分均高于全国常模,差异有统计学意义(P<0.01);自责、幻想、退避3种应对方式与SCL-90各因子均呈正相关(P<0.01),合理化与强迫症状、人际关系敏感、抑郁、焦虑、敌对、偏执呈正相关(P<0.01或P<0.05),解决问题与强迫症状、人际关系敏感、抑郁、敌对、偏执、精神病性呈负相关(P<0.01或P<0.05),求助与偏执呈负相关(P<0.01).结论 监狱女警的心理健康水平低于全国成人常模,成熟型的应对方式有利于维护心理健康.