Oral health promotion among Finnish adolescents between 1977 and 1989

In Finland a national, comprehensive preventive oriented oralhealth programme was implemented in 1972. Oral health habitsand services as well as their development were followed in theJuvenile Health Habit Study programme between 1977 and 1989.Postal questionnaires were sent to 12–18 year old Finnsevery second year from 1977. The response rates of the nationallyrepresentative samples were 79–88%. The most recent questionnairewas answered by 3220 adolescents (80%). Use of oral health services increased continuously from 1977to 1985. In 1985 there was a slight decrease in the use among16 and 18 year olds. Sex and socioeconomic differences in theuse of these services disappeared in 1985. In 1989 half of theadolescents had received instruction about oral hygiene butonly 20% about use of sugar during their last dental visit. Oral hygiene habits (toothbrushing and use of dental floss)improved slowly but continuously during the whole period Dailyuse of dental floss was still rare and one-third of the Finnishboys did not brush their teeth daily in 1989. The most common sugar-containing products used daily were hotsweet drinks (sugar-sweetened coffee, tea and hot chocolate).Use of sugar-sweetened coffee and cakes decreased but that ofsweets, soft drinks, sugar-sweetened tea and hot chocolate remainedunchanged. Use of sweetened yogurt increased slightly. The positive trend in the use of oral health services and oralhealth behaviour can be explained by the national oral healthpromotion programme. Extensive toothbrush and toothpaste advertisementsand changes in teenagers' life-style associated with urbanizationof the society may also have contributed to the improvements.     

Health risks for older US adolescents in foster care: the significance of important others' health behaviours on youths' health and health behaviours

Background   Little research to date has examined older foster care youths' physical health and the associated health behaviours of the youth and important people in their lives (parents, peers and important non-parental adults).
Methods   Older US foster care youth ( n = 188) completed surveys on multiple indicators of self-report physical health, including number of chronic health problems, overall health and sick symptoms, as well as their own health-compromising behaviours and the health-compromising behaviours of important others.
Results   The findings suggested that boys, particularly those placed in non-kin foster homes and group homes, appeared to have poorer health than did boys in these placement settings. Girls, however, engaged in similar levels of health-compromising behaviours as boys. Furthermore, the health-compromising behaviours of peers and important non-parental adults (VIPs), but not parents, were associated with youths' health behaviours, which, in turn, were associated with the physical health status of the foster care youth.
Conclusion   Youth report high levels of health-related problems and involvement in health-compromising behaviours. Healthcare practitioners can help to improve the health and well-being of children in foster care by becoming informed about adolescent health behaviours, as well as the health behaviours of their peers and other important non-parental adults.     

GP Clinic: promoting access to primary health care for mental health service clients

Objective: To evaluate an innovative rural service offering comprehensive primary health care for mental health service clients. Design: A formative evaluation using mixed methods. Setting: A rural NSW community. Participants: Fifteen health care providers and 120 adult clients. Intervention: A monthly clinic held in a general practice to provide primary health care for clients of the community mental health team. Main outcome measures: Client utilisation and clinic activity data. Provider views of service effectiveness, possible improvements and sustainability. Results: The GP Clinic has operated successfully for 2.5 years without access block. Some 52% of clients had no physical illness and 82% were referred to other health and community services. In total, 40% continued to attend the clinic while 32% went on to consult a GP independently. Client access to care improved as did collaboration between the community mental health team and primary care providers. Conclusion: The GP Clinic is a straightforward and flexible service model that could be used more widely.     

青少年睡眠习惯与心理健康的相关性研究

目的 分析青少年中睡眠习惯和心理行为健康之间的相关性,为预防和改善青少年群体心理健康提供参考依据。方法 通过分层整群抽样的方式调查了4 966名11～20岁的青少年。青少年睡眠卫生评估量表修订版(M-ASHS)用来测量其睡眠状况及行为习惯。儿童长处和不足问卷(Strengths and Difficulties Questionnaire,SDQ)用来评估青少年心理行为健康状况。结果 参与调查的青少年中,46.4%工作日平均每天睡眠时间少于8 h,7.6%周末平均睡眠时间少于8 h,47.5%工作日入睡时间晚于22:00点,39.8%周末入睡时间晚于22:30,45.2%周末觉醒时间晚于8:00,22.55%睡眠规律性差;8.7%的青少年存在心理行为问题,在控制了潜在的混杂因素后,工作日平均睡眠时间少于8 h/d (OR=1.77,CI:1.13~2.76,P=0.012),周末的平均睡眠时间少于8 h/d(OR=1.65,CI:1.12~2.43,P=0.011),工作日入睡时间晚于22:00点(OR=1.73,CI:1.30~2.31,P<0.001),周末入睡时间晚于22:30点(OR=1.37,CI:1.07~1.77,P=0.014),周末的觉醒时间晚于8点(OR=1.30,CI:1.02~1.66,P=0.032),睡眠不规律(OR=3.11,CI:2.41~4.01,P<0.001)等5个睡眠习惯变量与青少年心理问题显著相关。结论 应加强对青少年的睡眠卫生教育,帮助其培养良好的睡眠习惯,特别是充足的睡眠时间和规律的作息习惯,以促进其心理健康。     

Supporting positive dimensions of health,challenges in mental health care

This paper will explore two contrasting paradigms in mental health care and their relationship to evidence-based practice. The biomedical perspective of pathogenesis and the health perspective of salotogenesis are two major diverse views in mental health care. Positive dimensions of health are traditionally viewed as software not suitable for statistical analysis, while absence of symptoms of disease are regarded as measurable and suitable for statistical analysis and appropriate as a foundation of evidence-based practice. If the main goal of mental health care is to enhance subjectively experienced health among patients, it will not be sufficient to evaluate absence of symptoms of disease as a measure of quality of care. The discussion focuses on the paradox of evidence-based absence of illness and disease versus subjectively experienced health and well-being as criterions of quality of care in mental health care.     

Medicaid managed care and the unmet need for mental health care among children with special health care needs

OBJECTIVE: To determine the association between Medicaid managed care pediatric behavioral health programs and unmet need for mental health care among children with special health care needs (CSHCN). DATA SOURCE: The National Survey of CSHCN (2000-2002), using subsets of 4,400 CSHCN with Medicaid and 1,856 CSHCN with Medicaid and emotional problems. Additional state-level sources were used. STUDY DESIGN: Multilevel models investigated the association between managed care program type (carve-out, integrated) or fee-for-service (FFS) and reported unmet mental health care need. DATA COLLECTION/EXTRACTION METHODS: The National Survey of CSHCN conducted telephone interviews with a sample representative at both the national and state levels. PRINCIPAL FINDINGS: In multivariable models, among CSHCN with only Medicaid, living in states with Medicaid managed care (odds ratio [OR]=1.81; 95 percent confidence interval: 1.04-3.15) or carve-out programs (OR=1.93; 1.01-3.69) were associated with greater reported unmet mental health care need compared with FFS programs. Among CSHCN on Medicaid with emotional problems, the association between managed care and unmet need was stronger (OR=2.48; 1.38-4.45). CONCLUSIONS: State Medicaid pediatric behavioral health managed care programs were associated with greater reported unmet mental health care need than FFS programs among CSHCN insured by Medicaid, particularly for those with emotional problems.     

初中生心理问题早期干预的前瞻性研究

【目的】观察初中生心理卫生问题早期干预的效果。【方法】应用自编儿童心理卫生调查问卷、症状自评量表(Symptom Checklist 90,SCL-90)、父母养育方式评价量表(Egma Minnen av Bardndosnauppforstran,EMBU),以整群抽样的方法,抽取社区所属的中学1 585人为研究对象,随机选取其中一所中学841人为干预组,另一所中学744人为对照组,对干预组进行为期2年的综合干预,前瞻性观察心理卫生问题的干预效果。【结果】干预前干预组检出139人,阳性率16.53%;对照组117人,阳性率15.74%,两组比较差异无显著性(χ2=0.19,P>0.05)。干预前两组父母养育方式量表各因子得分比较,差异无显著性(P>0.05)。经过对干预组进行2年综合干预后,对两组再重新进行问卷调查,评估干预效果。干预组心理卫生问题检出阳性率明显下降至9.23%;对照组检出阳性率为16.50%,两组相比差异有非常显著性(χ2=18.41,P<0.01)。干预组在干预后父母养育方式量表各因子得分与对照组比较,差异有显著性(P<0.05)。【结论】对初中生的心理卫生问题进行早期干预,有助于减少心理问题的发生。     

Evaluation of community mental health services: comparison of a primary care mental health team and an extended day hospital service

Alongside mental health policies emphasising the need to focus on people experiencing serious, long-term problems, recent general healthcare policy is leading to the development in the UK of a primary care-led National Health Service. While most primary care-led mental health initiatives have focused on supporting general practitioners (GPs) in managing milder depression and anxiety, this article describes an evaluation comparing primary care-based and secondary care-based services for people with serious long-term problems. A survey of service users was carried out at three points in time using three measures: the Camberwell Assessment of Need, the Verona Satisfaction with Services Scales and the Lancashire Quality of Life Profile. Staff views were sought at two time intervals and carers' views were obtained towards the end of the 2-year study period. The results indicate that both services reduced overall needs and the users' need for information. The primary care service also reduced the need for help with psychotic symptoms whereas the secondary care service reduced users' need for help with benefits and occupation. There were no major differences in terms of satisfaction or quality of life. Primary care-based services therefore appear to have the potential to be as effective as more traditional secondary care services. However, a more comprehensive range of services is required to address the whole spectrum of needs, a conclusion supported by the views of staff and carers.     

Improving access to and outcomes from mental health care in rural Australia

OBJECTIVE: Rural Australians face particular difficulties in accessing mental health care. This paper explores whether 51 rural Access to Allied Psychological Services projects, funded under the Better Outcomes in Mental Health Care program, are improving such access, and, if so, whether this is translating to positive consumer outcomes. DESIGN AND METHOD: The paper draws on three data sources (a survey of models of service delivery, a minimum dataset and three case studies) to examine the operation and achievements of these projects, and makes comparisons with their 57 urban equivalents as relevant. RESULTS: Proportionally, uptake of the projects in rural areas has been higher than in urban areas: more GPs and allied health professionals are involved, and more consumers have received care. There is also evidence that the models of service delivery used in these projects have specifically been designed to resolve issues particular to rural areas, such as difficulties recruiting and retaining providers. The projects are being delivered at no or low cost to consumers, and are achieving positive outcomes as assessed by standardised measures. CONCLUSION: The findings suggest that the rural projects have the potential to improve access to mental health care for rural residents with depression and anxiety, by enabling GPs to refer them to allied health professionals. The findings are discussed with reference to recent reforms to mental health care delivery in Australia.     

聋哑青少年人格特征与心理健康关系

目的 了解聋哑青少年人格特征与心理健康现状及相互关系,为其人格与心理健康教育提供依据.方法 采用艾森克人格问卷(EPQ)与症状自评量表SCL-90对随机抽取的吉林、广东省3所聋哑学校158名学生进行调查.结果 聋哑青少年精神质(P)得分明显高于常模(t_男=5.99,t_女=5.47,P<0.01),神经质(N)得分明显低于常模(t_男=-7.11,t_女=-3.35,P<0.01),男性内外向(E)得分明显低于常模(t_男=-4.86,P<0.01),女性内外向(E)得分与常模差异无统计学意义(P>0.05);SCL-90的9个因子分均值均明显高于国内青年常模(t=4.21~12.74,均P<0.01);SCL-90若干因子与EPQ中P、N分量表呈正相关(r=0.16~0.31,P<0.05,P<0.01),与E分量表呈负相关(r=-0.19~-0.35,P<0.05,P<0.01),N、E维度对心理健康水平具有预测作用(P<0.01).结论 聋哑青少年精神质倾向较高,情绪稳定,男性较为内向,其心理健康水平低于全国青年平均水平,且较多地受到人格特征中情绪性、内外向的影响.     

Substance use and mental health problems as predictors of HIV sexual risk behaviors among adolescents in foster care

This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an HIV prevention program. Final logistic regression models indicated that delinquent behavior and marijuana use were the most significant predictors of engaging in any one HIV risk behavior. Adolescents who reported delinquent behaviors, alcohol use, and marijuana use and who were female were more likely than their counterparts to engage in vaginal sex without using a condom. Future research is needed to further identify risk and protective factors for substance use, mental health problems, and HIV sexual risk behaviors among adolescents in foster care. HIV prevention efforts for these vulnerable adolescents should target those with substance use and delinquent behaviors.     

Physician, practice, and patient characteristics related to primary care physician physical and mental health: results from the Physician Worklife Study

OBJECTIVE: To study the impact that physician, practice, and patient characteristics have on physician stress, satisfaction, mental, and physical health. DATA SOURCES: Based on a survey of over 5,000 physicians nationwide. Four waves of surveys resulted in 2,325 complete responses. Elimination of ineligibles yielded a 52 percent response rate; 1,411 responses from primary care physicians were used. STUDY DESIGN: A conceptual model was tested by structural equation modeling. Physician job satisfaction and stress mediated the relationship between physician, practice, and patient characteristics as independent variables and physician physical and mental health as dependent variables. PRINCIPLE FINDINGS: The conceptual model was generally supported. Practice and, to a lesser extent, physician characteristics influenced job satisfaction, whereas only practice characteristics influenced job stress. Patient characteristics exerted little influence. Job stress powerfully influenced job satisfaction and physical and mental health among physicians. CONCLUSIONS: These findings support the notion that workplace conditions are a major determinant of physician well-being. Poor practice conditions can result in poor outcomes, which can erode quality of care and prove costly to the physician and health care organization. Fortunately, these conditions are manageable. Organizational settings that are both "physician friendly" and "family friendly" seem to result in greater well-being. These findings are particularly important as physicians are more tightly integrated into the health care system that may be less clearly under their exclusive control.     

Associations of multiplicity of comorbid health conditions,serious mental illness,and health care costs

Using a nationally representative U.S. sample, this study analyzed the effects of serious mental illness (SMI) and comorbid medical conditions on the cost of health care. The results of path model indicated that SMI and comorbid health conditions each increased total health care costs. Additionally, individuals with SMI were likely to have more comorbid medical conditions, which in turn, increased total health care costs. Findings raise awareness of an increased risk of medical conditions among individuals with SMI and the concern of high expenditures associated with comorbid SMI and medical conditions.     

Rural physical health care services for people with serious mental illness: A nursing perspective

Objective: To understand nurse perspectives on the physical health needs of their mental health clients and how well rural services are meeting their overall care needs. Design: Focus groups with semistructured format. Setting: Community mental health care in a regional and rural district of Queensland. Participants: Thirty‐eight nurses in public mental health care. Results: The major themes were (i) stigma of mental illness, (ii) barriers to accessing physical health care services, (iii) nurse adaptations under demands, and (iv) community and integration towards better overall health. Nurses integrate overall care and foster its continuity for people with physical and mental co‐morbidity and can be supported much better in sustaining this. Conclusion: Access and continuity of physical health care experienced by all Australians is exacerbated for people in rural areas. Physical health of people with serious mental illness residing in remote Australia needs to be a national health priority.