Connections,Collisions, and Complimentarity: The Dynamic of Health Care Chaplain,Parish Nurse and Parish Clergy Collaboration

ABSTRACT

Parish nurses, health care chaplains, and community clergy can collaborate to create communities of wholeness. As these professionals extend their care and mission into the community, chaplains, parish nurses, and community clergy have opportunities for collaboration. These collaborative efforts come as a result of personal connections that can lead to collisions in priorities and philosophies but can also be productive complimentarity as they learn to work together for a common mission. Through connection this potential for collision or complimentarity, the community itself can participate with health professionals and clergy to help people be better, feel better, and carry suffering better.     

Time Trends and Predictors of Suicide Among Mental Health Outpatients in the Department of Veterans Affairs

Using merged Veterans Affairs (VA) and National Death Index data, this study examined changes in suicide rate among three cohorts of VA mental health outpatients during a time of extensive bed closures and system-wide reorganization (1995, N = 76,105; 1997, N = 81,512; and 2001, N = 102,184). There was a decreasing but nonsignificant trend in suicide rates over time—13.2, 11.4, and 10.3 per 10,000 person-years, respectively. Multivariable predictors of suicide included both younger and older ages (U-shaped association). At the facility level, there was an association between greater per capita outpatient mental health expenditure and reduced suicide risk. The model also showed a protective effect associated with increased mental health spending on inpatient services, and that outpatients at facilities with larger mental health programs, as measured by patient volume, were at greater risk for suicide than were those in smaller programs. Although more chronic patients may have been underrepresented to some extent as a result of the sampling methodology, these findings provide generally reassuring evidence that overall suicide rates have not been adversely affected by VA system changes. Nevertheless, they highlight the importance of funding for mental health services as well as the implications of changing demographics in the VA population.     

Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice

ABSTRACT

Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.     

社区残疾人心理健康状况调查和干预初探

目的了解社区残疾人心理健康状况,探索社区卫生服务人员为残疾人身心康复服务的方法。方法随机将120例持有残疾证、登记在册的残疾人分成干预组和对照组,后两组各脱落2例,共完成116例。对干预组进行团体咨询、个别辅导和家庭干预等心理综合干预,为期1年;对照组则不干预。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对研究对象进行评估。结果干预后,干预组SAS、SDS量表分数分别为(35.91±7.16)分、(35.83±10.79)分,明显优于对照组(40.56±8.54)分、(40.03±10.73)分,差异具有显著性(P0.05,P0.01)。在改善人际关系和家庭支持方面,干预组也明显优于对照组(P0.05,P0.01)。结论心理综合干预对残疾人的心理康复有积极作用。     

武汉市社区妇女家庭暴力与创伤后应激障碍的相关性研究

目的 了解武汉市社区妇女家庭暴力的流行特征,分析家庭暴力与创伤后应激障碍（PTSD）的关系,为提高女性心理健康水平提供依据。方法 采用横断面研究方法,以在武汉市某社区卫生服务中心进行妇科检查的女性作为研究对象,调查其一般特征、社会支持、伤害情况、家庭暴力及PTSD流行情况。采用 χ²检验、t检验、Cochran-Armitage趋势检验分析PTSD组与健康组间差异,logistic回归分析PTSD与家庭暴力的关系。结果 家庭暴力终身发生率为29.36%,心理暴力、身体暴力和性暴力的发生率分别为28.28%、6.60%和3.55%;PTSD的总患病率为4.73%。遭受家庭暴力的女性患PTSD的风险是未遭受暴力女性的2.11倍（OR=2.11,95%CI：1.04～4.29）;同时遭受身体与心理暴力的女性发生PTSD的风险是未受暴力女性的5.06倍（OR=5.06,95%CI：1.91～13.42）。结论 家庭暴力与PTSD存在较强的相关性,对遭受家庭暴力的妇女应进行心理疏导,降低PTSD的发生风险。     

地震致伤残住院儿童少年创伤后应激障碍随访研究

创伤后应激障碍(PTSD)指个体经历强烈精神创伤后出现的精神障碍~([1]),主要表现为反复闯入意识、梦境的创伤体验、高度惊觉状态、与社会隔离和回避行为以及注意力不集中、创伤性事件回忆困难等.患者社会功能受损,有的终身丧失工作和生活能力.本研究以从地震灾区因伤残转运到医院住院治疗的儿童少年患者这一特殊群体为对象,探讨PTSD检出率、症状特征及其影响因素.     

Exploring the Role and Potential of Probiotics in the Field of Mental Health: Major Depressive Disorder

The field of probiotic has been exponentially expanding over the recent decades with a more therapeutic-centered research. Probiotics mediated microbiota modulation within the microbiota–gut–brain axis (MGBA) have been proven to be beneficial in various health domains through pre-clinical and clinical studies. In the context of mental health, although probiotic research is still in its infancy stage, the promising role and potential of probiotics in various mental disorders demonstrated via in-vivo and in-vitro studies have laid a strong foundation for translating preclinical models to humans. The exploration of the therapeutic role and potential of probiotics in major depressive disorder (MDD) is an extremely noteworthy field of research. The possible etio-pathological mechanisms of depression involving inflammation, neurotransmitters, the hypothalamic–pituitary–adrenal (HPA) axis and epigenetic mechanisms potentially benefit from probiotic intervention. Probiotics, both as an adjunct to antidepressants or a stand-alone intervention, have a beneficial role and potential in mitigating anti-depressive effects, and confers some advantages compared to conventional treatments of depression using anti-depressants.     

Characterization and Comparison of Physical and Mental Health Profiles and Department of Veterans Affairs Health Care Utilization Patterns among Operation Iraqi Freedom/Operation Enduring Freedom Women Veterans in Puerto Rico versus the United States

BackgroundResearch on the physical and mental health profiles and patterns of health care use among women veterans receiving health care from the Department of Veterans Affairs (VA) on the island of Puerto Rico is lacking.MethodsThis cross-sectional study examines differences in physical and mental health conditions, and patterns of VA health care use, between women veterans of the Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) era who were using VA facilities in Puerto Rico (n = 897) and those using U.S.-based VA facilities (n = 117,216) from 2002 to 2015.ResultsResults of fully adjusted logistic regression models revealed that OIF/OEF women in Puerto Rico had heightened risk for global pain-related disorders (i.e., any pain) (adjusted odds ratio [AOR], 1.45; 95% confidence interval [CI], 1.22–1.71), back pain (AOR, 1.83; 95% CI, 1.56–2.14), diabetes (AOR, 1.42; 95% CI, 1.03–1.95), hyperlipidemia (AOR, 3.34; 95% CI, 2.80–3.98), major depression (AOR, 1.78; 95% CI, 1.53–2.06), and bipolar depression (AOR, 1.66; 95% CI, 1.34–2.04). They also evidenced greater risk for a host of reproductive health conditions and had higher average annual use of VA health care than their U.S. counterparts.ConclusionsOIF/OEF women receiving VA health care in Puerto Rico evidenced a greater burden of physical illness, depression, and heightened use of VA health care services relative to their U.S. counterparts. Providers’ increased awareness of the physical and mental health care needs of this population is warranted. Research efforts that help to identify efficient and effective strategies to provide culturally tailored and/or personalized health care for this population could also be useful.     

Determinants of Return to Work in Patients with Hand Disorders and Hand Injuries

Introduction Return to work (RTW) in patients with hand disorders and hand injuries is determined by several determinants not directly related to the physical situation. Besides biomedical determinants, work-related and psychosocial determinants may influence RTW as well. This study is conducted to investigate the influence of these potential determinants on RTW in patients with hand disorders and hand injuries. Methods Included 91 patients who were operatively treated for a hand disorder or a hand injury, and who were employed prior to surgery. Patients answered several questionnaires on the aforementioned categories. Potential determinants significantly related to RTW in a univariate analysis were entered in a logistic regression for the total group and the acutely injured patients separately. Results Pain, accident location, job independence and symptoms of post-traumatic stress disorder (PTSD) were univariately associated with RTW. Pain was a determinant for late RTW in the total group and accident location and symptoms of PTSD in the acutely injured group. Conclusion Pain, accident location and symptoms of PTSD were most important in resuming work in hand injured patients or in patients with a hand disorder. These findings may indicate that attention should be paid to the treatment of pain, and to the development of symptoms of PTSD during rehabilitation. It may be necessary to make extra efforts aimed at RTW in patients who sustained their injury on the job.     

Smoking Response to Health and Medical Spending Changes and the Role of Insurance

Severe health shocks provide new information about one's personal health and have been shown to influence smoking behaviors. In this paper, we suggest that they may also convey information about the hard to predict financial consequences of illnesses. Relevant financial risk information is idiosyncratic and unavailable to the consumer preceding illness, and the information search costs are high. However, new and salient information about the health as well as financial consequences of smoking after a health shock may impact smoking responses. Using variation in the timing of health shocks and two features of the US health care system (uninsured spells and aging into the Medicare program at 65), we test for heterogeneity in the post‐shock smoking decision according to plausibly exogenous changes in financial risk exposure to medical spending. We also explore the relationship between smoking and the evolution of out‐of‐pocket costs. Individuals experiencing a cardiovascular health shock during an uninsured spell have more than twice the cessation effect of those receiving the illness while insured. For those uninsured prior to age 65 years, experiencing a cardiovascular shock post Medicare eligibility completely offsets the cessation effect. We also find that older adults' medical spending changes separate from health shocks influence their smoking behavior. Copyright © 2016 John Wiley & Sons, Ltd.     

An Overview of 9/11 Experiences and Respiratory and Mental Health Conditions among World Trade Center Health Registry Enrollees

To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2–3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income <$25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600–70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event.     

浙江省15岁及以上人群精神疾病流行病学调查

  目的  全面了解湖南省≥15岁人群双相情感障碍的患病情况及分布特点。  方法  在2015年2 — 6月,采用多阶段、系统、整群、随机抽样方法在湖南省123个县（市、区）随机抽取≥15岁居民,以增补后的一般健康问卷12项（GHQ-2）和重性精神疾病异常行为线索调查问卷作为筛选工具,以美国精神障碍诊断与统计手册– 第四版（DSM-Ⅳ-TR）轴Ⅰ障碍定式临床检查（SCID-I/P）作为诊断工具,对湖南省双相情感障碍的患病率及分布特征、影响因素和患病特点等进行分析。  结果  本次调查第一阶段完成调查户口中≥15岁摸底人口为84 242人,实际共72 999人（86.65 %）完成增补后的一般健康问卷12项（GHQ-12）及异常行为线索调查问卷。经过第一阶段筛查,共5 869人进入第二阶段调查。第二阶段调查发现双相情感障碍患者75例（双相Ⅰ型43例,双相Ⅱ型27例,其他双相5例）,时点患病率为1.03 ‰（95 % CI = 0.79 ‰～1.26 ‰）,终生患病率为1.49 ‰（95 %CI = 0.75 ‰～2.18 ‰）。双相情感障碍患者以情感症状为主要表现的59例,占78.67 %,其中有16例（21.33 %）伴有精神病性症状。城市和农村患病率分别为1.03 ‰（37例）、1.02 ‰（38例）,差异无统计学意义（χ² = 0.00,P > 0.05）;男性和女性患病率分别为0.99 ‰（36例）、1.06 ‰（39例）,差异无统计学意义（χ² = 0.074,P > 0.05）;年龄分布：45～59岁患病率（0.471 ‰）最高,患病27例（占比36.00 %）;其次是≥60岁的患病率（0.421 ‰）,患病25例（占比33.33 %）。双相障碍患者的文化程度相对较低,小学及以下文化程度64例（85.33 %）,以农民33例（44.00 %）、失业或无业的20例（26.67 %）;婚姻状况以已婚（29例,38.67 %）、离异（23例,占30 %）为主,其次是未婚（19例,25.33 %）。  结论  此次调查基本掌握了湖南省双相情感障碍的患病情况、流行特点、分布规律及患病特点,为制订精神卫生相关政策提供了比较全面客观的依据。     

The association between discrimination and PTSD in African Americans: exploring the role of gender

ABSTRACT

Background: Research has demonstrated the adverse impact that discrimination has on physical and mental health. However, few studies have examined the association between discrimination and symptoms of posttraumatic stress disorder (PTSD). There is evidence that African Americans experience higher rates of PTSD and are more likely to develop PTSD following trauma exposure than Whites, and discrimination may be one reason for this disparity.

Purpose: To examine the association between discrimination and PTSD among a cross-sectional sample largely comprising African American women, controlling for other psychosocial stressors (psychological distress, neighborhood safety, crime).

Methods: A sample of 806 participants was recruited from two low-income predominantly African American neighborhoods. Participants completed self-report measures of PTSD symptoms, perceived discrimination, perceived safety, and psychological distress. Information on neighborhood crime was obtained through data requested from the city. Multivariate linear regression models were estimated to assess adjusted relationships between PTSD symptoms and discrimination.

Results: Discrimination was significantly associated with PTSD symptoms with a small effect size, controlling for relevant sociodemographic variables. This association remained consistent after controlling for psychological distress, perceived safety, and total neighborhood crime. There was no evidence of a gender by discrimination interaction. Participants who experienced any discrimination were significantly more likely to screen positive for PTSD.

Conclusions: Discrimination may contribute to the disparate rates of PTSD experienced by African Americans. PTSD is associated with a range of negative consequences, including poorer physical health, mental health, and quality of life. These results suggest the importance of finding ways to promote resilience in this at-risk population.     

健康教育在社区慢性病防治中的地位

目的探讨健康教育在社区慢性病防治中的效果,为社区慢性病综合防治提供依据。方法采用随机分层抽样的方法,抽取辖区内284例中老年慢性病患者,有针对性地开展健康教育,2年后通过问卷调查对患者慢性病知识知晓率及不良生活行为方式改变程度进行统计学分析。结果健康教育后患者对高血压诊断标准、有效控制血压的方法、冠心病的定义、心绞痛的类型、糖尿病的诊断标准和糖尿病的并发症以及危害相关健康知识的知晓率明显升高,与健康教育前相比,差异有统计学意义(P<0.05)。健康教育后患者吸烟、过量饮酒、嗜咸、高脂饮食和缺乏锻炼等不良生活行为发生率明显降低,与健康教育前比较,差异有统计学意义(P<0.05)。结论慢性病与人们的健康知识水平和行为习惯有密切关系,健康教育是提高国民健康素质及社区开展慢性病干预的有效途径,可有效降低慢性病的患病率。     

重庆市社区卫生服务机构现状分析及其发展对策

社区卫生服务作为我国卫生事业的重要部分,其提供的基层卫生服务,关乎社区居民的身体健康和医疗服务水平,社区卫生服务可及性、持续性、综合性、协调性和基础性六大特点决定了其必须走可持续发展之路。以社区卫生服务的可持续发展为出发点,通过分析重庆市社区卫生服务现状,结合可持续发展的理念,初步探讨和提出了社区卫生服务可持续发展的对策,为我国社区卫生服务的发展探索出路。