上海市儿童福利院39例孤残婴幼儿依恋类型分布调查

目的:了解上海市儿童福利院孤残婴幼儿依恋类型及特点,为机构照料模式探索新方法。方法:对39例8～24个月的孤残婴幼儿采用"陌生情境法"进行依恋类型的测评。结果:上海市儿童福利院内孤残婴幼儿与其主要照料者之间的依恋类型为安全型依恋(B型)占20.5%,不安全型依恋占79.5%,其中焦虑/回避型(A型)占43.6%,焦虑/矛盾型(C型)占35.9%,未发现混乱型(D型)。结论:上海市儿童福利院内婴幼儿安全型依恋的比例远低于家庭内婴幼儿安全型依恋。     

上海市儿童福利机构孤残婴幼儿生长发育综合评估研究报告

目的:上海市社会福利中心为准确了解上海地区儿童福利机构孤残婴幼儿养育现状,为政府和儿童福利机构提供科学依据,便于进行早期干预,促进孤残婴幼儿身心健康发展。方法:进行为期一年半的上海市儿童福利机构孤残婴幼儿生长发育综合评估研究,定时测量上海地区儿童福利机构孤残婴幼儿体格发育衡量数字;完善智力测试方案;新建心理行为测试(气质、依恋类型测试)。结果:上海市儿童福利机构孤残婴幼儿体格发育衡量数字均低于中国九市城区婴幼儿;孤残婴幼儿整体营养状况良好;社会适应能力发展明显落后,早期接受各种干预对其明显有效;气质、依恋类型分布与社会正常婴幼儿差异有统计学意义,应依据婴幼儿的气质特征因材施教,特别在生后6～18月依恋形成的关键期加强对依恋的培养。结论:上海市儿童福利机构孤残婴幼儿生长发育综合评估能比较全面地了解孤残婴幼儿在儿童福利机构养育状况,以便进行早期干预,促进身心健康发展。     

福利院工作人员社会支持状况及其影响因素的调查分析

【】 目的：了解福利院工作人员社会支持状况及其影响因素,为提高工作人员的社会支持提供理论支持。方法：选择70名上海市杨浦区某福利院工作人员作为研究对象,发放问卷70份,收回有效问卷61份,有效率为87.14%。采用领悟社会支持量表(PSSS)对工作人员的社会支持进行调查,采用健康商数量表(HQ)对工作人员的健康状况进行调查。 结果：领悟社会支持得分为(64.08?7.99)分,其中领悟家庭支持为(23.39?3.43)分,领悟朋友支持为(19.64?3.40)分,领悟其它支持为(21.05?3.36)分。61名工作人员社会支持系统处在低等水平为1.64%,影响工作人员社会支持的因素包括：是否值夜班、工作年限、个人信仰、人际关系、饮食、营养与饮食习惯。结论：福利院应重视工作人员的社会支持情况,加强对员工的关心,增进员工之间的交流互动。     

Citizens advice in primary care: a qualitative study of the views and experiences of service users and staff

Objectives

To examine the views and experiences of staff and users of Citizens Advice Bureau (CAB) services located in general practice, and to identify key factors perceived as contributing to the intervention’s effectiveness.

Study design

A qualitative study in an urban and rural primary care setting in the UK.

Methods

Semi-structured, face-to-face interviews (n = 22) with primary care and practice staff, CAB advisors and 12 service users.

Results

Key positive service features reported by all groups were: the confidential, non-stigmatizing and familiar environment of a general practitioner’s (GP) surgery; the ability to make appointments and experienced advisor availability and continuity. Outcomes for service users were described as financial gain, managed debt, and beneficial social and mental health impacts. Perceived staff benefits were appropriate referral and better use of GP consultation time.

Conclusion

Welfare advice in primary care has financial benefits and was perceived by participants to offer health and other benefits to patients and staff. However, while perceptions of gain from the intervention were evident, demonstration of measurable health improvement and well-being presents challenges. Further empirical work is needed in order to explore these complex cause-effect links and the cost-effectiveness of the intervention.     

Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA

Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation.     

Empowerment in drug treatment: dilemmas in implementing policy in welfare institutions

This article analyzes how and why welfare policies focusing on empowerment as users' self-management create dilemmas in medically assisted drug treatment in Denmark. Drawing on ethnographic fieldwork, the article points to two sets of dilemmas by focusing on the relationship between legal and institutional setups and staff and user possibilities for agency. The first dilemma concerns how to provide user self-management and individualized services and the actual possibilities of effectuating this in welfare institutions imbued by limited resources, manpower, and local rules. The second, how to create a balance between notions of user self-management and legal demands of control regarding substitution medicine. The article analyzes empowerment as a policy arguing that implementation of policy--also called policy in practice--is integral to policy studies, rather than a domain that is separate from policy making.     

Social inequalities in 'sickness': European welfare states and non-employment among the chronically ill

The aim of this paper is to examine educational inequalities in the risk of non-employment among people with illnesses and how they vary between European countries with different welfare state characteristics. In doing so, the paper adds to the growing literature on welfare states and social inequalities in health by studying the often overlooked 'sickness'-dimension of health, namely employment behaviour among people with illnesses. We use European Union Statistics on Income and Living Conditions (EU-SILC) data from 2005 covering 26 European countries linked to country characteristics derived from Eurostat and OECD that include spending on active labour market policies, benefit generosity, income inequality, and employment protection. Using multilevel techniques we find that comprehensive welfare states have lower absolute and relative social inequalities in sickness, as well as more favourable general rates of non-employment. Hence, regarding sickness, welfare resources appear to trump welfare disincentives.     

Payment contracts in a preventive health care system: a perspective from operations management

We consider a health care system consisting of two noncooperative parties: a health purchaser (payer) and a health provider, where the interaction between the two parties is governed by a payment contract. We determine the contracts that coordinate the health purchaser–health provider relationship; i.e. the contracts that maximize the population's welfare while allowing each entity to optimize its own objective function. We show that under certain conditions (1) when the number of customers for a preventive medical intervention is verifiable, there exists a gate-keeping contract and a set of concave piecewise linear contracts that coordinate the system, and (2) when the number of customers is not verifiable, there exists a contract of bounded linear form and a set of incentive-feasible concave piecewise linear contracts that coordinate the system.     

Health inequalities between lone and couple mothers and policy under different welfare regimes – The example of Italy,Sweden and Britain

This study examines the welfare state arrangements and social policy, living conditions and health among lone and couple mothers in three contrasting policy environments: Italy, Sweden and Britain. These countries fall into distinctive family policy categories. Data were drawn from representative national household interview surveys. The findings highlight both similarities and differences. Lone mothers had significantly worse health than couple mothers in all three countries, were more likely to suffer material disadvantage and were much more likely to be smokers. They could be considered a disadvantaged group in particular need in all three countries, irrespective of the policy regime. It is the differences between countries, however, in the experiences of lone and couple mothers that indicate that the prevailing policy regime really does matter. There were telling differences in the prevalence of lone motherhood, their composition, rates of joblessness, poverty and health status of lone mothers in relation to couple mothers in each country. These may be traced back to the main policy regimes of each country, but also partly reflect culture and traditions. The study illustrates an emerging approach to investigating the health inequalities impact of complex social policy contexts. The experiences of lone mothers as a group may serve as a ‘litmus’ test of how each family policy system is operating and offer an early warning of adverse impacts when policies change.     

Applying fractal analysis to heart rate time series of sheep experiencing pain

The objective assessment of pain is difficult in animals and humans alike. Detrended fluctuation analysis (DFA) is a method which extracts “hidden” information from heart rate time series, and may offer a novel way of assessing the subjective experience associated with pain. The aim of this study was to investigate whether any fractal differences could be detected in heart rate time series of sheep due to the infliction of ischaemic pain. Heart rate variability (HRV) was recorded continuously in five ewes during treatment sequences of baseline, intervention and post-intervention for up to 60 min. Heart rate time series were subjected to a DFA, and the median of the scaling coefficients (α) was found to be α = 1.10 for the baseline sequences, 1.01 for the intervention sequences and 1.00 for the post-intervention sequences. The complexity in the regulation of heartbeats decreased between baseline and intervention (p ∼ 0.03) and baseline and post-intervention (p ∼ 0.01), indicating reperfusion pain and nociceptive sensitization in the post-intervention sequence. Random time series based on Gaussian white noise were generated, with similar mean and variance to the HRV sequences. No difference was found between these series (p ∼ 0.28), pointing to a true difference in complexity in the original data. We found no difference in the scaling coefficient α between the different treatments, possibly due to the small sample size or a fear induced sympathetic arousal during test day 1 confounding the results. The decrease in the scaling coefficient α may be due to sympathetic activation and vagal withdrawal. DFA of heart rate time series may be a useful method to evaluate the progressive shift of cardiac regulation toward sympathetic activation and vagal withdrawal produced by pain or negative emotional responses such as fear.