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151.

Objectives

This paper introduces some epistemology about mental health developments and how it leads to reconsider the landscape of clinical practices.

Materials

From an epistemological point of view, the author reviews several writings about mental hygiene going back to the nineteenth century. It clarifies the common roots between mental hygiene and mental health. Then, the article examines the first World Health Organization's reports, that shed light on psychiatric and political issues in the middle of the twentieth century, which allows to reach out the foundations of mental health as a discursive practice.

Results

The review of the developments from “mental hygiene” to “mental health” highlights a general climate of redesign on many points: Mental health as a discursive space is characterized by an expansion of its address field. It is not only addressed to specialists, psychiatrist and psychiatric patients, but also, and above all, to every citizen. Psychic suffering, as far as mental illness, is part of a larger whole including what preserves or deteriorates the proper functioning of an individual, within society. Mental health is at the crossroads of financial, political, citizen's rights and social interests. Contemporary mental health relies on the objectives of prevention and promotion. Clinical practices are organized by some discourses with mental health as a key word. At the turn of 2000s, French psychiatry has been impacted by many shuffles in health policies. However, the roots of these restructuring are not new, as they update an old interest in safeguarding public health, funds and welfare. Psychic suffering and mental illness recently enter the field of “psychic disability”. It brought social benefits such as financial assistance from the state. It may also contribute to the campaigns of awareness-raising and destigmatization among the public opinion. However, financial and subjective effects do not perfectly match. In other words, the benefits listed above should not lead to desert the listening of the users’ experience in its singularity.

Conclusions

The developments of mental health point out a reorganization in the psychiatric field and open new clinical challenges. If the spaces of singularity and universal are in a permanent relationship, the political and economic sides cannot answer or evacuate the subjectivity posed by the subject and his suffering. It should lead to focus on a clinical practice driven by a subtle listening, which does not exclude psychopathology and recognizes the importance of alterity.  相似文献   
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Abstract

This article follows up a pilot project to help educate local nurses and patient educators on freely available consumer health resources. The Outreach Coordinator and Clinical Librarian at an academic medical center created a one-hour in-person and online class with continuing education credit and an online guide. Nurses frequently act as patient educators at the bedside and are therefore an important target for consumer health education. While nurses in an urban setting may have more access to educational opportunities, these opportunities are needed even more in rural settings. Librarians can obtain funding to travel and teach classes at rural community hospitals.  相似文献   
155.
Health care expenditure in Germany shows clear regional differences. Such geographic variations are often seen as an indicator for inefficiency. With its homogeneous health care system, low co‐payments and uniform prices, Germany is a particularly suited example to analyse regional variations. We use data for the year 2011 on expenditure, utilization of health services and state of health in Germany's statutory health insurance system. This data, which originate from a variety of administrative sources and cover about 90% of the population, are enriched with a wealth of socio‐economic variables, data on pollutants, prices and individual preferences. State of health and demography explains 55% of the differences as measured by the standard deviation while all control variables account for a total of 72% of the differences at county level. With other measures of variation, we can account for an even greater proportion. A higher proportion of variation than usually supposed can thus be explained. Whilst this study cannot quantify inefficiencies, our results contradict the thesis that regional variations reflect inefficiency. Copyright © 2015 John Wiley & Sons, Ltd.  相似文献   
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评价天津市各辖区基本公共卫生服务的资源配置效率,寻求有效的资源配置措施和方法,为进一步优化卫生资源配置提供参考依据。方法利用数据包络分析,对天津市16辖区的基本公共卫生服务进行效率评价。结果天津市基本公共卫生服务的资源配置效率整体不高,仅有5辖区达到了规模最优,多数区非DEA有效,且投入过剩与产出不足并存。结论为了达到最优的基本公共卫生服务效率,政府及各级基本公共卫生服务机构必须有效地完善、落实相关政策,优化资源投入结构,统筹地区差异,加强资源供给管理,提高资源利用效率。  相似文献   
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Purpose

The objective of the study was to define factors associated with adolescent and young adult (AYA) experiences with private time and having discussed confidentiality and the impact of these experiences on improving delivery of clinical preventive services.

Methods

In 2016, a nationally representative sample of 1,918 US AYAs (13- to 26-year-olds) was surveyed. Survey questionnaire domains were based on prior research and Fishers' information-motivation-behavior skills conceptual model. Data were weighted to represent US households with AYA and analyzed to identify factors independently associated with ever experiencing private time and discussions of confidentiality with a regular health-care provider (HCP). We examined the association of these experiences on AYA attitudes about health care.

Results

Fifty-five percent of female and 49% of male AYA reported ever having had private time with an HCP and 55% of female and 44% of male AYA had spoken to an HCP about confidentiality. Independent predictors of having experienced private time and confidentiality included older age, race, higher household income, gender of the provider, amount of years with the provider, and involvement in risk behaviors. AYA who had experienced private time and confidentiality discussions had more positive attitudes about their providers, were more willing and comfortable discussing sensitive topics, and thought that these discussions should happen at younger ages.

Conclusions

Although confidentiality and private time are important to AYA, many are not experiencing these components of care. Providing private time and discussions of confidentiality can improve the delivery of health care for young people by enhancing positive youth attitudes about preventive care.  相似文献   
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