Predictors of Burden of Family Caregivers of Women with Substance Use Disorders or Co-Occurring Substance and Mental Disorders

ABSTRACT

This study examined the impact of having a female family member with a substance use or co-occurring disorders on family caregivers. Predictors of subjective burden (worry, stigma, and displeasure) and objective burden (family disruption) on caregivers and on types of burden were explored. Subjects were 82 women receiving substance abuse treatment and their family member providing most social support. Behavioral problems of the recipient and lack of social support for caregivers predicted higher levels of family member burden, with different types of social support predicting different types of burden. Having a dual disorder did not predict family member burden. Implications of findings for treatment are discussed.     

新农合对四川藏区的减贫效应分析

The New Rural Cooperative Medi-cal System ( hereafter NRCMS) in Tibetan areas of Sichuan was started in Wenchuan in 2005 , and by 2008 covered all of the province’s Tibetan areas. This paper studies the effects of the NRCMS on im-proving the health of and alleviating poverty for farmers and herdsmen in Tibetan area of Sichuan. Most parts of the Tibetan areas of Sichuan are located in high altitude districts. Thirty two coun-ties of these areas are classified as “National Pov-erty Counties”. Poverty and disease go hand in hand in these regions. Kashin-Beck disease and hydatid disease are the major endemics in the pas-toral and agro-pastoral areas of Sichuan. Endemic, infectious and chronic diseases are widespread in Sichuan’s Tibetan areas. More than 70% of pa-tients are workers from 20 to 60 years old. Disea-ses are more prevalent in women than in men. Kashin-Beck disease and hydatid disease are cur-rently incurable. Patients suffer from health prob-lems, which leads to a decrease in their income and the heavy burden of medical expenses. The new rural cooperative medical system alleviates the negative effects of farmers’ falling into, or back in-to poverty due to disease. However, the existing medical compensation mechanism is not sufficient to solve the problem. The greatest impact of NRCMS on the farmers and herdsmen in Sichuan’s Tibetan areas is that the system has gradually changed local people’s medi-cal behavior, as well as their underlying ideas a-bout medicine: they begin to believe in hospitals. In particular, more pregnant women are choosing to give birth in hospitals, which reduces the rate of infant mortality and postpartum diseases, and im-proves the health of women. Since the full coverage of the NRCMS in 2008 , the number of people participating in the system has reached the overall average level of Si-chuan province. By analyzing the data before and after the implementation of this system, and meas-uring the impact of the system on people’s health, it can be found that the NRCMS’s role in serving the vulnerable population, such as the elderly and infant children, is more marked. Since the implementation of the NRCMS, all administrative villages in Sichuan Tibetan areas have established village clinics, which solved the problem of a shortage of medicines and doctors in those areas. Farmers and herdsmen have conven-ient access to medical treatment, enhancing the ac-cessibility of medical service. After the implemen-tation of the NRCMS, the health of the elderly population in rural areas has improved. Infant mor-tality rates have dramatically fallen. The implementation of the NRCMS improved the medical service capacity of township hospitals and village clinics. And the NRCMS has brought the township hospitals and village clinics into its scope of compensation, which greatly promotes the utilization of primary medical services in Tibetan areas. The poverty reduction effect of the NRCMS can be analyzed from two aspects:Firstly, the im-
provement in health leads to increased income, be-cause good health can promote labor productivity. Meanwhile, the increase in income will in turn im-prove the overall level of health. Secondly, the in-patient and outpatient compensation rate is raised year by year, which reduces the medical fees of farmers, and prevents them from falling back into poverty.     

从“疾病”的隐喻看中国现代文学的多重现代性

“疾病”在中国近现代作家的作品当中富有浓厚的隐喻意义。从现代性的研究范式来看,作家们笔下的“疾病”所负载的道德批评和价值判断是各不相同的,这种微妙的差别体现了作家们独特的美学追求,而更为深刻的,它体现了“现代性”这一概念本身的丰富和驳杂。“疾病”及其隐喻给我们提供了一条寻访中国文学现代性多副“面孔”的便捷途径。     

To Tell or Not to Tell: The Disclosure of Events in the Therapist's Life to the Patient

Happy or disturbing events may occur in a therapist's life during the course of treatment that intrude on the therapeutic process whether or not their true nature is disclosed to the patient. Therapists are not immune from experiencing acute, chronic, and even terminal illnesses, divorce, remarriage, adopting a child, mourning the death of a parent or significant other, or major accomplishments. In many instances such events affect the treatment process by disrupting appointments, necessitating sudden absences, restricting a therapist's emotional availability and physical stamina, or altering the therapist's mood and affect. In other instances, patients may be aware of such events, at least unconsciously, because of subtle changes in the therapist. Drawing on self psychology and intersubjectivity this paper explores the reasons for therapist self-disclosure of these events based on an assessment of the patient's developmental needs and the nature of the transference. It will discuss ways of making such disclosures therapeutic.     

Ethnicity, migration and health: A population-based study of 338 refugees from Latin America, 396 nonrefugee immigrants from Finland and 161 from southern Europe and 996 age-, sex- and education-matched controls from Sweden

This article shows the influence of being a refugee from Latin America or a nonrefugee immigrant from southern Europe or Finland on self-reported illness, controlling for social factors and lifestyle. The study population consisted of 338 Latin American refugees, a random sample of 396 Finnish and 161 southern European immigrants and 996 age-, sex- and education-matched Swedish controls. The data were analysed unmatched with logistic regression (multivariate analysis) in main effect models. The strongest independent risk indicator for long-term illness was being a Latin American refugee (estimated odds ratio (OR)=2.96, 95% confidence interval (CI)=2.19–3.82). There was a significant association between being a Latin American refugee and period prevalence, ill health and unsatisfied need for care. Being a southern European or Finnish immigrant was a risk indicator of ill health but was not associated with the other dependent factors. Not feeling secure in daily life was a strong risk indicator for long-term illness and ill health (estimated OR=1.89, 95% CI=1.26–2.76 and OR=3.04, 95% CI= 1.97–4.48) respectively). Being a Latin American refugee was equal in importance to traditional risk factors such as overweight and not taking regular exercise for long-term illness and ill health.     

HOW HEALTH STATUS IMPACTS THE TYPES OF INFORMATION CONSUMERS SEEK ONLINE

A few studies examine what types of health information people seek online, yet we know little about how this varies by health status. To examine this question we used data collected from a random sample of 2,038 adults for the Pew Internet and American Life Project, which asked respondents in the United States whether they searched for 16 different types of information. These 16 topics were grouped into three broad areas, including medical conditions and treatments, health issues (e.g. diet and smoking cessation), and providers and payment (e.g. a particular hospital). To build on prior literature, two measures of health status were used: a self-report and the presence of a medical condition. The data suggest that health status impacts the types of health or medical information people seek on the Internet. Self-reported health status was not significantly related to any of the topics; however, respondents diagnosed with a disability or chronic disease were more likely to seek medical information on 13 of the 16 topics addressed. These include specific diseases or medical conditions, medical treatments or procedures, experimental treatments or medicines, alternative treatments or medicines, pharmaceutical or over-the-counter drugs, diet, immunizations, smoking cessation, depression, sexual health, environmental health hazards, a particular physician or hospital, and Medicaid/Medicare (governmental health programs in the United States for the poor and elderly). These results suggest that individuals in the United States who have a medical condition are more likely than healthy individuals to research most health topics online. The Internet can provide consumers with a wealth of information on issues of health and illness, yet healthcare providers need to educate consumers to be cautious given the range in quality.     

Unmet service needs of families of young children with chronic illnesses and disabilities

Data about health and educational services were collected from 187 families with young children (under two years) who have chronic illnesses and disabilities. The purpose was to assess parents' satisfaction with services their families received and to identify families' unmet service needs as well as the reasons for these unmet needs. Although families' ratings of the adequacy of services are relatively high, 28% of the families report unmet service needs. The unmet needs most often reported are occupational, physical, or speech therapy; respite care/child care; and special education. Lack of funding is the most commonly given reason for unmet needs. Children with multiple impairments are at highest risk for unmet needs. Only 22% of unmet needs reported at the initial interview have been met by the time of the six-month follow-up. Increased coordination and monitoring of services across service sectors are indicated. Her research interests include the effects of disability on family identity and families' responses to minority stress. She received her Ph.D. from the University of Minnesota. She gratefully acknowledges Shelley Blazis and Nadav Casuto for statistical consulting. Her research interests focus on the impact of chronic illness and disability on families. She received her Ph.D. from the University of Minnesota. Her research interests include families and health and chronic illness and disability in children. She received her Ph.D. in Family Social Science at the University of Minnesota. His areas of interest include neurodevelopmental outcomes of low birth weight infants and training in developmental pediatrics. He was graduated from the University of Minnesota Medical School. His areas of interest include adolescents with chronic illness and disabilities, adolescent sexual decision making, and international adolescent health care issues. He was graduated from Howard University College of Medicine was awarded his earned doctorate in Health Policy from the University of Minnesota. Preparation of this article was supported by the National Institute on Disability and Rehabilitation Research Grant #H133890012.     

对大学生课外体育锻炼中加强自我医务监督的思考

通过对大学生课外体育锻炼中运动性伤病产生原因的分析,提出了大学生应加强科学锻炼和自我医务监督的思考,以期达到指导大学生科学锻炼身体,减少运动性伤病的发生,有效增强体质,不断提高健康水平和学习效率的目的。     

微信公共账号传播的机制与策略

微信及其用户创造了一个全新的时代。微信公共账号的产生则赋予了其更多的媒介特质,也为传播学研究提供了更为丰富的实践。微信公号具有大众传播属性、人际传播功能和交互式传播特点,它体现了传播学研究中的使用与满足理论、强关系理论和受众碎片化趋势。同时微信公号传播也存在诸多困境,可以从定位、媒介融合、互动、推广、监管等方面进行改进,实现其长远发展。     

疾病的宗教性建构：理解农民因病信教的行为和动机——以一个河南乡村基督教会为例

近年来,农村地区的一些村民在身患重病难以得到医疗救治的情况下,会尝试将信仰基督教作为一种替代治疗方案。本文通过对豫东陈村教会农民因病信教现象的深入分析,发现本土化的基督教为农民的疾病医治提供了一套“合理”的解释体系,通过“神医结合”的方式,有些农民疾病的痊愈得以可能。“疾病”和“苦难”被赋予新的意义,被构建为“神拣选之前的考验”,继而导向皈依基督教。农民最初的功利性信仰,会经由宗教仪式的出席和宗教实践的参与而逐渐形成对基督教的理解和体验。农民因病信教成为基督教民间信仰化和本土化实践的重要表现形式。