住院医师规范化培训中的人文思想

本文论述在现代医学模式指导下,加强人文思想在住院医师规范化培训中的渗透,以促进住院医师规范化培训人员人文素养的提升。住院医师规范化培训中蕴含着许多人文思想因素,只要在教学中有意识地进行人文思想渗透,就可以有效地促成住院医师规范化培训人员人文思想的形成,进而提高住院医师规范化培训人员的人文素养。     

Minding the gap: health and social care provider perceptions of parental communication and Black-Canadian youths’ sexual health

Abstract

Health and social care providers’ perceptions of Black-Canadian parent-youth sexual health communication has important implications for addressing knowledge gaps in the provision of services to young people and their parents. Providers’ perceptions are crucial as they often act as advisers in tailoring programmes or services to the perceived needs of parents and youth. To understand these perceptions, 17 semi-structured in-depth interviews were conducted with providers who worked with African, Caribbean or Black (ACB) parents and youth in Toronto, Ontario, Canada. Critical Race Theory was used to help guide the interpretation of findings. The findings revealed providers believed that many parents were unlikely to explicitly discuss sexual health or HIV prevention with young people. Additionally, providers perceived that the content of and approach to parent-youth sexual health communication differed between African and Caribbean clients. Moreover, providers believed that both parents’ and young people’s sex and gender impacted the quality, content and style of sexual health communication and had important implications for programme development. Overall, findings suggest a need for understanding the development of providers’ perceptions of this communication, ways to address these perceptions and further parent-provider collaboration to promote Black youths’ sexual health.     

Comparison of Patient Food Intake,Satisfaction and Meal Quality Between Two Meal Service Styles in a Geriatric Inpatient Unit

Abstract

This pilot study evaluated the introduction of a bistro evening meal service in a geriatric inpatient unit by comparing patient intake, satisfaction and meal quality of this new service to the usual central preplated service. Ten meals were observed under each condition (n?=?30; mean age 79?years, 47% male). Data were collected on intake of each meal component (none, ¼, ½, ¾, all; converted to energy and protein using known food composition data), patient satisfaction with meals (meal flavor/taste, appearance, quality, staff demeanor; seven-point scale) and meal quality (sensory properties, temperature; five-point scale). Independent t-tests were used to compare energy and protein intakes between bistro and preplated services. There was no difference in mean energy or protein intake (energy: 2524?±?927?kJ vs. 2692?±?857?kJ, p?=?0.612; protein: 29?±?12?g vs. 27?±?11?g, p?=?0.699) patient satisfaction or meal quality between the bistro and preplated meal services. Patients were provided with fewer meal items during the bistro service, but ate a higher proportion of what was provided to them. Implementing a bistro service did not increase intake, satisfaction or meal quality in this study, suggesting that meal plating may be only one of many factors influencing intake and satisfaction of older inpatients.     

Health care service use among vulnerable adolescents

Abstract

This article describes the patterns of health care service use among a cohort of vulnerable adolescents with a history of homelessness and uses the Expanded Behavioral Model for Vulnerable Populations to examine factors associated with use of ambulatory and emergent care. We incorporated a health care interview into an existing longitudinal study of newly homeless adolescents, at their 24-month assessment (n?=?183) and assessed their sociodemographic characteristics, including living situation, health insurance rates, having a regular source of care, substance use and health care service use in the past 3 months. By the 24-month assessment, 63% of youth had returned home and 37% were currently homeless. In comparing youth who were currently homeless and those who had returned home, we found similar rates for ambulatory care use (48%) and for emergent care use (15%). The most common reason for seeking ambulatory care related to sexually transmitted disease (STD) testing/HIV testing/reproductive health for both groups. However, currently homeless youth were more likely to seek emergent care for trauma (15% vs. 4%, p?<?0.01) and for common conditions such as skin problems/respiratory infections/gastrointestinal problems/other problems (16% vs. 7%, p?<?0.05). Using multivariate logistic regression, we found older age [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.0–6.5] and health insurance (OR 2.3, 95% CI 1.1–4.5) to be associated with use of ambulatory care; however, only older age (OR 2.7, 95% CI 1.0–7.0) was found to be associated with use of emergent care. Housing status, emotional distress and substance use were not found to be associated with ambulatory or emergent care use. Our findings suggest that facilitating health insurance coverage for vulnerable adolescents with a history of homelessness may lead to increased use of ambulatory care services and may consequently prevent use of emergent care services for conditions that may be treated in the ambulatory care setting.     

A study of young people who inject drugs: an opportunity to decrease high risk injecting by improving knowledge about hepatitis C prevention

The population of young people who inject drugs (PWID) displays a unique constellation of features that are not found in other groups who are at risk of acquiring hepatitis C: they exhibit a smaller pool of existing infection and a higher incidence of unsafe injecting. This means there is vast opportunity to prevent the spread of hepatitis C for young PWID. This article uses survey data collected from clients of a community pharmacy needle exchange scheme in New South Wales, Australia, to describe the extent of unsafe injecting among young PWID, their knowledge about hepatitis C prevention and use of services. It examines whether poor knowledge and service use are related to unsafe injecting. A sample of 215 respondents aged 18–25 years was compared to 1464 respondents aged 26 years or older. Young respondents engaged in riskier injecting practices than their older counterparts, with higher proportions saying they had shared needles and other injecting equipment. Moreover, those who had shared equipment did so in a more risky manner than older respondents by sharing with a larger number of people and with people who were possibly less well-known to them, such as casual sex partners. While knowledge about hepatitis C transmission was good among young respondents, it was significantly worse than that of older respondents. More importantly, however, this poorer knowledge was related to both increased needle sharing and increased ancillary equipment sharing. Many studies do not observe a relationship between knowledge and risk behaviour but the findings of this study suggest a pressing opportunity to improve knowledge of young PWID. While it is unlikely that better knowledge will alone prevent infection among young people, it is a necessary starting point and, in the current case, has the potential to decrease young people’s risk of acquiring hepatitis C.     

Mental Health System Reform

ABSTRACT

In recent years many countries have embarked on various types of health and mental health reform. These reforms have in large part been driven by governments' concerns for cost containment which has, in turn, been driven by an increasing process of global marketization and the need to control national deficits. A critical issue in these reforms is the increased emphasis on the use of “market mechanisms” in the delivery of health and mental health services.

This paper uses a policy analysis framework to compare recent developments in the mental health sector in Canada, the United States, Britain and Australia. The common framework to be used for this will focus on: the defining characteristics of the society; legislative mandate; sectorial location (within or separate from health sector); funding streams; organising values of the system; locus of service delivery; service technologies; the role of social work; interprofessional dynamics; the role of consumers; and evaluation of outcomes at multiple levels. This analysis provides an opportunity to explore similarities and differences in mental system reform and in particular identify the challenges for social work in the field of mental health in the 21st century.     

Strategies for Consumer Health Reference Training

ABSTRACT

Public librarians are challenged to provide consumer health reference services. Libraries cannot afford extensive health and medical collections; moreover, librarians fear giving the wrong answer or providing medical “advice.” Most public libraries have access to the Internet, and this, along with adequate staff training, can provide the public librarian with the tools to handle all but the most difficult consumer health questions. This paper describes a model three-hour training session for public librarians covering the inherent difficulties in the consumer health reference interview. Using a handful of reliable and easy-to-navigate Web sites, the challenges in consumer health reference can be overcome.     

Satisfaction with Health-Related Educational Workshops:

The present study examined correlates of the perceived quality of four educational conferences. Specifically, the study examined the relationships of ratings of subjective overall conference quality with environmental and logistical aspects of the conferences. The results showed that ratings of room quality as well as ratings of meeting structure were significantly related to ratings of overall conference quality. Follow-up overall conference ratings, measured up to one year after the conferences, were predicted by initial ratings of food quality.     

Beyond the GAO Cleveland Study:

The General Accounting Ofice (GAO) study of home care services in the Cleveland area is a prominent attempt to inform the selection of clients for these services. This paper critiques two major portions of the CAO study: the "break even" analysis relating level of client impairment to the comparative costs ofcare in home and institutional settings, and the analysis of risk of institutionalization as a function of client characteristics. Derailed review shows serious flaws in the GAO methodology which undermine the credibility of its estimates of relative service costs and risks of institutionalization. This paper proceeds to place the GAO study within a conceptual framework that permits more systematic consideration of the issue ofclient selection. Analysis of a model of institutionalization shows that the strategy recommended by GAO of targetling the highest risk individuals may be an inefficient way to use home care resources. Factors pertinent to client selection include not only risk of institutionalization but also level of private support, changes in risk and private support occasioned by an increase in public support, number of clients in the target group, and political attractiveness of the target group.     

Black/White Differences in Nutritional Risk Among Rural Older Adults

Abstract

In order to examine race differences in nutritional risk among participants in rural home-delivered meals programs, we conducted a secondary analysis using routinely collected data on 245 participants from two rural North Carolina counties. After constructing three categories of High Nutritional Risk from the putative High Risk category of the Nutrition Screening Initiative's (NSI) DETERMINE Checklist and using adjusted logistic regression, we found black participants 3.7 times more likely than white participants to be at the highest level of nutritional risk, with a further increase in odds when economic need was present. This underscores the importance of understanding racial and cultural differences in the development and delivery of targeted and tailored nutritional services to older adults.