"Women with self-esteem are healthy women": community development in an urban settlement of Guayaquil

Guayaquil, home to two million people, is Ecuador's main port city. El Guasmo is an urban settlement in the south of the city. In 1984, CEPAM, an Ecuadorian women's nongovernmental organization, began working in El Guasmo Norte, the oldest and most established area of El Guasmo. CEPAM employs an integrated approach to its work with poor urban women on health issues, legal advice, and group formation, based upon a gender analysis of life in the area. This article describes the group's work in El Guasmo Norte, explaining how women came to understand that their health and well-being were determined by their status as poor urban women, and that as a result, they decided to establish their own health center. Sections cover the determinants of urban women's health, reflection and action, the health center, the concept of integration, participating in health services, and lessons learned.     

The evaluation ranking scale: a new methodology for assessing satisfaction

Most patient satisfaction scales produce high, undifferentiated levels of reported satisfaction that fail to detect program areas that consumers do not like. Methodological problems apparently contribute to these results. An alternative procedure, the Evaluation Ranking Scale (ERS), was formulated and tested. A 2 X 3 design was employed with 246 public health center patients randomly assigned to one of two measurement techniques (ERS vs. a global measure) and one of three informational sets. A secondary group of subjects was a convenience sample of 26 staff members, which allowed comparisons of staff evaluations of the health center to patients' evaluations of the health center. Compared to the global measure, the ERS provided more specific information about particular program components, was more discriminating, and resulted in mean satisfaction scores that were significantly lower. This new approach may be a more effective technique for assessing the psychosocial effectiveness of human service programs.     

Attitudes Towards Gambling,Gambling Problems,and Treatment Among Hispanics in Imperial County,CA

Gambling problems are associated with a wide range of serious negative personal, social, health, and mental health consequences and are an important public health concern. Some data suggest that gambling problems may be more prevalent among Hispanics, but few studies have been conducted in this community. The aim of the current study was to gather community-based, gambling-related data in order to increase understanding of gambling problems and their treatment in the Hispanic community. We conducted a mixed-methods study of gambling behavior and attitudes towards gambling, those with gambling problems, and professional treatment for gambling problems in a publicly funded health center serving a primarily Hispanic clientele. Study participants included clinic staff and clinic patients. All participants completed a brief, self-report survey; however, staff participated in a focus group on gambling issues and patients were interviewed individually about gambling issues. Nearly 80 % of patients had gambled in the past month, as compared to about 36 % of clinic staff. Survey data showed that patients had many risk factors for gambling problems. Focus group and interview information indicated that most viewed gambling problems as a form of addiction, the elderly were seen as being at increased risk for gambling problems, and gambling outings represented one of the few recreational opportunities in the region. The majority of both staff and patients believed that there was a need for gambling-related treatment services in the county; however, a notable minority of patients said that they would first seek help from a trusted relative or family member. Possible avenues to increase awareness of, screening for, and treatment for gambling problems may include collaborations with publicly funded health care centers and the training of promotoras to serve as an interface between health services and the community.     

Alaskan villagers' views on problem drinking: "those who forget"

Statewide statistics suggest that problems relating to alcohol abuse represent a major public health problem for Native Alaskans but very little is known about alcohol use on a community level, due to deficient reporting mechanisms and a lack of relevant research. The research reported here was designed to begin to fill this stated need. Alcohol use patterns, the extent of drinking, and associated problems as perceived by residents of two Alaskan Eskimo villages are documented. The structure and effects of alcohol programs in the villages, which represent local attempts to manage alcohol, are also examined. The research demonstrates that it cannot be assumed that all Native Alaskan communities have the same scale of drinking and consequent problems. Differential response to alcohol programs, which have essentially the same structure, is demonstrated and related to the recent development of contrasting levels of community organization in the two villages, which share a common cultural tradition. The utility of a comparative case study approach in examining alcohol problems in Native American communities and the need for expanded research for informed alcohol program planning and implementation are emphasized.     

Including At-Risk Adolescents in Their Own Health and Mental Health Care

Summary

As urban adolescents encounter serious health and mental health risks, they present the allied health professions with important opportunities for health promotion and risk reduction interventions. However, the prevailing emphasis on adolescents' risk behaviors rather than on their vulnerability has limited our capacity to understand and serve them. Further limiting are the widely held myths that adolescents as a whole have few health problems and that they are poor judges of their own needs. This article presents an overview of current theories of adolescent risk and vulnerability and suggests Youth Development as an overarching framework for understanding both. Experience within a comprehensive, adolescent health and mental health center demonstrates how to meaningfully engage adolescents in their own health care from the start.     

A Survey of Wellness/Healthy Lifestyling on College and University Campuses

Abstract

Mental health providers at university counseling and health centers should be alert to the possibility that college students with previously unrecognized attention deficit hyperactivity disorder (ADHD) may present for initial evaluation at their centers. This study was a systematic chart review of 42 students at an Upper Midwest university who were diagnosed with ADHD during calendar year 1993. Diagnoses were made by the treating psychiatrist, who reviewed records for presenting problems; recent associated problems; previous evaluations as a child, adolescent, or adult; and associated problems in childhood. Presenting problems included ADHD symptoms, mood symptoms, nonspecific learning disability, and academic underachievement. Associated problems were depressive disorders, anxiety disorders, drug and alcohol abuse or both, dependency, legal problems, learning disabilities, and eating disorders. Thirty-three percent had been evaluated for academic or behavior problems as children, and 36% had sought previous psychological care for non-ADHD symptoms as adults. Thirty-one percent were presenting at the university health center for their first evaluation. Childhood histories showed educational underachievement, learning disabilities, and behavior problems.     

"Living well in later life": an overview of the National Service Framework for Older People in England

The National Service Framework (NSF) for Older People is a set of standards produced by the Department of Health in England in 2001 to overhaul the health and social service delivery systems over a 10-year period aimed at optimizing the care received by older adults. The NSF arose from broader social and health care reforms that likewise sought the establishment of performance assessment, augmented consumer sovereignty, and greater coherence across health and social services. The United States shares with England similar problems with care for its older adults, strategies for improvement, and obstacles to successful implementation of change.     

Was Freud a Medical Scientist or a Social Theorist? The Mysterious "Development of the Hero"

Rather than viewing Freud as a presumptuous Viennese physician who late in life attempted to "apply" some of his provocative psychological speculations to various social phenomena, this essay argues that from first to last, Freud was a social theorist. Indeed, what drew Freud to the study of biology and medicine was precisely the hope of addressing scientifically the most fundamental cultural problems: the nature of man and his culture; the origins of religion, morality, and tradition and the nature of their extraordinary power; the sources of social order and disorder; the direction of contemporary cultural development; and, finally, the problem of how to live in a disenchanted and psychologically impoverished world. Reading Freud in this manner moves his "cultural" texts from the periphery to the center of his work and makes possible an appreciation of the more complex, coherent, and illuminating social theory that lies at its heart.     

Why do children placed out-of-home because of parental substance abuse have less mental health problems than children placed for other reasons?

The purpose of this paper was to compare children placed out-of-home because of parental substance abuse (PSA) with children placed for other reasons (NPSA), and to explore the association between PSA and mental health problems in a Norwegian sample of 6- to 12-year-old children in out-of-home care (N = 109). Several group differences were found related to the children themselves, their families and the Child Welfare case. The PSA children had less total difficulties, conduct problems and emotional problems than the NPSA children assessed by the teachers on the Revised Rutter Scale. However, both groups had far more mental health problems than children in general. The most important variable explaining the group difference in all subgroups of mental health problems was the extent of prosocial behavior in the children, but being placed for behavioral problems also explained a significant part of total difficulties and conduct problems. Variables like gender, discipline problems and socioeconomic conditions did not have a significant effect. The conclusion of the study was that prosocial behavior might be regarded as an important protective factor against mental health problems, which is an argument for investing in programs focusing on enhancing the placed children's mastering strategies.     

Quality improvement in patient distribution at a major university student health center

Healthcare in a major university setting poses unusual challenges and great opportunities. Two traditionally challenging areas in patient distribution are the initial intake of allergy/immunization patients and the triage of outpatients in the general medical clinic. The authors describe the use of the FOCUS-PDCA quality improvement (QI) problem-solving process for each situation. After identifying major problems, the health center established cross-functional teams of experts representing the allergy/immunization and general medical clinics. The teams analyzed the problems with a flow chart and undertook studies to further elucidate causes and potential solutions. They listed potential solutions in order of priority and submitted them to the student health center director for review and initiation. Each team then used the PDCA (plan-do-check-act) cycle to put approved solutions into effect. Permanent improvements made in each area resulted in a more effective and efficient patient distribution system, favorable staff comment, and greater patient satisfaction.     

Quality Improvement in Patient Distribution at a Major University Student Health Center

Abstract

Healthcare in a major university setting poses unusual challenges and great opportunities. Two traditionally challenging areas in patient distribution are the initial intake of allergy/immunization patients and the triage of outpatients in the general medical clinic. The authors describe the use of the FOCUS-PDCA quality improvement (QI) problem-solving process for each situation. After identifying major problems, the health center established cross-functional teams of experts representing the allergy/immunization and general medical clinics. The teams analyzed the problems with a flow chart and undertook studies to further elucidate causes and potential solutions. They listed potential solutions in order of priority and submitted them to the student health center director for review and initiation. Each team then used the PDCA (plan-do-check-act) cycle to put approved solutions into effect. Permanent improvements made in each area resulted in a more effective and efficient patient distribution system, favorable staff comment, and greater patient satisfaction.     

Problem drinking patterns among African Americans: the impacts of reports of discrimination, perceptions of prejudice, and "risky" coping strategies

This research builds on a series of recent studies that have reported independent effects of personal experiences of racial discrimination on poor mental health outcomes. We suggest that for one mental health outcome, problem drinking, discrimination experiences have an impact not only via abridged socioeconomic attainment and the frustrations associated with institutionally limited opportunity structures, but also by directly increasing the likelihood of problem drinking. Moreover, we argue that personal experiences with discrimination help to foster a set of beliefs about the utility of drinking as a means of reducing stress that in the alcohol literature is referred to as "escapist" drinking. Escapist drinking is proposed as an intervening mechanism that is associated with a higher probability of alcohol-related mental health problems. Using data from the 1999-2000 National Survey of Black Workers, we find that, independent of socioeconomic attainment, personal reports of discriminatory experiences have direct influences on problem drinking. Consistent with our hypotheses, we also find that the effects of personal reports of discrimination are at least partially mediated by the endorsement of beliefs that drinking provides an effective coping mechanism. We conclude that racial impacts on mental health outcomes reflect more than the "simple" effects of constrained socioeconomic attainment.     

Diagnosis of Pregnancy

Abstract

Contraceptive failure is a growing problem, especially on the college campus. Because of this, college health care providers are treating more and more college women not only for pregnancy-related problems, but women that present to the health center with other health complaints and are pregnant as well.

For these reasons, the diagnosis of pregnancy must always be entertained by all health care providers treating young women. Pregnancy must always be excluded before any tests or procedures are done that may be teratogenic. This is not only important for optimal health care, but also for medical-legal reasons.

This paper presents four unusual presentations of pregnancy and reviews the guidelines for diagnosis of pregnancy.     

Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment

This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.     

"That's So Gay!": Examining the Covariates of Hearing This Expression Among Gay, Lesbian, and Bisexual College Students

Abstract Objective: The investigators examined the health and well-being correlates of hearing the popular phrase "that's so gay" among gay, lesbian, and bisexual (GLB) emerging adults. Participants: Participants were 114 self-identified GLB students aged 18 to 25?years. Methods: An online survey was distributed to students at a large public university in the Midwest during winter 2009. Results: Participants' social and physical well-being was negatively associated with hearing this phrase, specifically feeling isolated and experiencing physical health symptoms (ie, headaches, poor appetite, or eating problems). Conclusions: College professionals and student leaders must acknowledge that the phrase is a form of heterosexist harassment. As such, policies addressing diversity and harassment should address students' use of this phrase, aiming to reduce its use. Additionally, colleges and universities should develop practices that counteract poorer well-being associated with hearing the phrase.     

Preliminary Validation of an Online DSM-Based Mental Health Referral Inventory

A brief online inventory was developed as a much needed corrective for the hundreds of unscientific tests that are used now by millions of people to self-diagnose mental health problems. The primary purpose of the new inventory is to refer people to mental health professionals for further evaluation when they are experiencing problems that might be diagnosable under DSM guidelines; it is not designed to diagnose, however. The inventory was found to be a valid and reliable measuring instrument based on analysis of data obtained from 3,403 subjects. The 54-item checklist looks for 18 common problems identified in the DSM-IV and takes from 5 to 10 min to complete. Test scores proved to be good predictors of a variety of self-reported criterion measures, including happiness, personal and professional success, history of hospitalization, history of therapy, current participation in therapy, employment, and level of education. Females were found to have slightly more mental health problems than males, but no differences in scores were found by race or ethnicity.     

Comparative influence of political, cost/benefit, and statistical information on administrative decision making.

The influence of three types of evaluation information was studied in simulated decisionmaking situations within a community mental health center setting. Twelve administrators reviewed one of two decision problems (direct services or indirect services funding) and were then presented political, cost/benefit and statistical information. After each presentation, the administrators rated the importance of each type of information for decision making. Only the cost/benefit data were rated as significantly influencing their decisions. The influence of each type was not dependent upon the decision problem, nor to length of time in administrative positions. The results were interpreted in terms of “who says what, how, and to whom. ” If evaluators desire a greater impact on the decision making behavior of community health administrators, they should consider employing a pay off-based evaluation strategy and providing cost/benefit information.