Policy incongruence and public health professionals' dissonance: the case of immigrants and welfare policy

The steady increase in immigrants to the United States has fueled a critical analysis of the process of allocation of health and social benefits to these newcomers. The myriad of interests and values surrounding this issue precipitated the formulation and adoption of the Personal Responsibility and Work Opportunity (Welfare Reform) Act of 1996. This dramatic welfare reform impacts federal, state, and local agencies that are required to determine the eligibility of benefits and manage the attendant consequences to the public as well as members of this vulnerable group. Especially challenging are the decisions confronting public health professionals who struggle to reconcile the resulting policy, programmatic mandates, and compliance imperatives with prevailing public health principles and practice norms. This paper proposes a framework for understanding the incongruence between the provisions of the law as it pertains to legal and illegal immigrants and public health values. The impact of policy incongruence and professionals' dissonance on public health practice norms is explored with an explicit focus on public health outcomes and legal implications. The examination of tuberculosis as a health example reveals the policy conflicts and public health dilemmas. Finally, the paper elicits a range of options available to public professionals for responding to these legal mandates.     

Assessment of general practitioners by video observation of communicative and medical performance in daily practice: issues of validity, reliability and feasibility

OBJECTIVES: To develop a video assessment method for General Practitioners (GPs) by analysing issues of validity, reliability and feasibility of observation of videotaped regular consultations. DESIGN: In a cross-sectional study consultations of 93 GPs were video recorded in the practice during 1 week. The GPs registered consultation and patient data in a logbook; 16 consultations per GP were selected using preset criteria. The quality of communicative and medical performance of these consultations was assessed by GP observers with a validated instrument. The validity of the procedure was evaluated by checking the content of each GP's sample using specific sample criteria. Selection bias was estimated by multiple regression analysis, with sample characteristics as independent variables and scores on communication and medical performance as dependent variables. The influence of observation on GPs and patients was assessed by a questionnaire. Generalizability theory was used to estimate reliability. Feasibility was assessed by conducting a questionnaire, by keeping accounts, and by checking the technical quality of the videotaped consultations. SETTING: Universities of Nijmegen and Maastricht, The Netherlands. SUBJECTS: General Practitioners (GPs). RESULTS: The domain of general practice was well covered in the samples; content validity was satisfactory. With regard to the sample characteristics, only the total duration of consultations appeared to correlate significantly with both the score on communication and the score on medical performance. A majority (71%) of GPs reported not being influenced by the observation, except in the first cases, and recognizing their usual daily performance in the videotaped consultations. An acceptable level of reliability was reached after 2.5 hours of observation, i.e. 12 cases by a single observer. The method was well accepted by both GPs and patients. The costs were pound250 per GP. CONCLUSIONS: Video assessment of GPs in daily practice according to the procedures described is a valid and reliable method, one which is useful for education and quality improvement. There is a trade-off between feasibility on one hand and validity, reliability and credibility on the other hand. Compared to investments in observation methods in standardized settings, the costs of video observation of GPs' actual performance are acceptable.     

挖掘原始创新潜力 创办研究型医院

我院在确立了研究型医院的定位后，采取了一系列的科研改革举措，如重新整合科研力量，发展重点学科，加大对科研的投入，设立院所青年科研启动基金，强调人才建设，加强科研管理工作等，这些举措对促进原始创新，增强我院核心竞争力将起到重要作用，从而使我院发展成国内最大、国际知名的心脏病研究中心。     

公立医院医疗技术人员兼职意愿的影响因素分析及对策

随着我国的改革开放和经济的快速发展,居民对医疗保健服务水平和质量提出了越来越高的要求,技术力量较薄弱的基层医疗机构、民营医院和诊所纷纷聘请公立医院的技术人员有偿兼职,愿意从事业余院外兼职的医疗技术人员除以增加收入为目的外,也较注重实现个人的价值.医疗技术人员从事业余兼职服务有利于医疗人力资源的充分利用,但也会带来许多问题,故应对这一行为进行规范化管理,兴利除弊.     

New‐Concept Part‐Time Employment as a Work‐Family Adaptive Strategy for Women Professionals with Small Children*

This study investigates how the option for new‐concept part‐time (NPT) employment influences the ability of mothers of preschool children working in professional occupations to successfully integrate work and family responsibilities. Female NPT professionals (n = 279) and female full‐time (FT) professionals (n = 250) were compared. The NPT group reported 20 fewer weekly work hours and about $18,000 less estimated annual household income than the FT group. They allocated this additional time primarily to caring for and nurturing their dependent children. They also reported less job‐related travel, unnecessary work, and work‐to‐family conflict, as well as greater work‐family success, childcare satisfaction, and family success. However, NPT mothers reported a more traditional division of labor in household responsibilities and less career opportunity and work success. Implications are presented and discussed.     

Capacity and Competence in Child and Adolescent Psychiatry

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The legal frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa.     

''I found myself to be a down to earth Dutch girl'': a qualitative study into learning outcomes from international traineeships

OBJECTIVE: To explore learning outcomes from international traineeships for undergraduate medical students. METHODS: In-depth interviews were conducted with 24 undergraduate medical students at Maastricht University Medical School, The Netherlands. The 24 subjects were selected by purposeful sampling. RESULTS: Students reported meaningful learning outcomes in 6 domains: medical knowledge; skills; international health care organisation; international medical education; society and culture, and personal growth. DISCUSSION: International traineeships appear to provide good opportunities for students to meet the requirements of globalisation as well as some of the generic objectives of undergraduate medical education. The tentative findings of this study need to be confirmed by further studies.     

护理专科生实习前心理健康状况及其影响因素分析

目的探索实习前护理专科生的心理健康状况与应对方式、社会支持的相关性及其影响因素,为护生心理咨询和实习前的岗前培训提供参考。方法采用症状自评量表(SCL-90)、简易应对方式量表(SCSQ)、领悟社会支持量表(PSSS)和自行设计的调查问卷对200名实习前护生进行调查。结果护生主要心理问题为强迫、人际关系敏感、抑郁和焦虑等。护生心理健康状况与社会支持、应对方式呈显著相关;经单因素Logistic回归分析,对专业不满意等10个变量与心理问题有关,经多因素Logistic回归分析,有4个变量进入回归模型。结论应加强实习前心理健康教育,重点加强应对技能训练和岗前培训。     

婴幼儿社会性和情绪发展的影响因素研究

[目的]了解武汉市1～3岁幼儿社会性和情绪发展的影响因素.[方法]采用整群随机抽样的方法抽取武汉市江汉、桥口、汉阳、武昌、江岸5城区1～3岁幼儿520名作为调查对象.应用自拟＂1～3岁幼儿社会人口学问卷＂及＂1～3岁幼儿社会性和情绪发展评价量表＂（美国）进行调查.原始调查表经核查整理后进行编码,用Foxpro6.0建立数据库,然后用SAS8.1进行逻辑检查及处理分析.[结果]各量表筛检出可疑阳性人数依次为外化量表112人,占总人数的21.5%;内化量表62人,占11.90%人;失调量表83人,占15.93%;反应能力量表111人,占21.31%,其中女童反应能力检出率（25.93%）高于男童（17.33%）;母亲孕期精神状况对儿童的外化行为、内化行为和失调行为的影响经x2检验,差异有显著性（P＜0.05）;父亲职业、父母文化程度和家庭结构不同的儿童外化量表评分的差异均有非常显著性（P均＜0.01）;不同家庭收入水平的儿童反应能力量表评分的差异有显著性（P＜0.05）.[结论]幼儿社会性和情绪发展受家庭环境和社会环境等众多因素的影响,应充分发挥父母在幼儿情绪发育上的积极作用,提高育儿者的自身素质;尽快制定一个适合我国幼儿社会性和情绪发展的评价量表,以促进幼儿身心的健康发展.     

2 771名不同职业女性妇女病普查结果分析

目的:了解不同职业女性妇女病患病情况。方法:对2 771名不同职业的女性进行常规妇科检查、宫颈刮片、子宫及附件B超、乳腺红外线扫描等检查。结果:不同职业女性妇女病总患病率是64.49%,生殖道感染、乳腺增生、子宫肌瘤及宫颈癌的患病率分别是59.94%、37.96%、11.76%、0.18%;不同年龄妇女的生殖道感染、子宫肌瘤、乳腺增生的患病率有非常显著性差异(P<0.01)。30~岁年龄组生殖道感染患病率最高(62.30%),40~岁及50~岁年龄组子宫肌瘤患病率较高,分别为18.54%、19.79%。30~岁及40~岁年龄组乳腺增生的患病率较高,分别为44.05%、42.51%。宫颈癌患病率在各年龄组差异无显著性(P>0.05)。不同职业女性子宫肌瘤、乳腺增生的患病率有非常显著性差异(P<0.01),不同职业女性宫颈癌患病率有显著性差异(P<0.05)。不同职业女性生殖道感染患病率无显著性差异(P>0.05)。个体业户的子宫肌瘤和乳腺增生患病率最高,分别为12.80%、39.34%。干部和个体户宫颈癌患病率较高,分别为0.98%、0.95%。结论:开展不同职业女性妇女病普查普治,对于提高妇女生殖健康是十分重要的。