Effects of Medicaid managed care policies on mental health service use among a national probability sample of children in the child welfare system

Children in the child welfare system are dependent upon Medicaid to finance services for their considerable mental health needs. This study examines the effects of Medicaid policies on mental health service use among a national probability sample of children in the child welfare system. Data for this study came from the National Survey of Child and Adolescent Well-Being, the Caring for Children in Child Welfare study, and the Area Resource File. Weighted multivariate logistic regression analyses were conducted to estimate effects of policy variables on children's use of mental health services, controlling for child-level covariates and county-level health resources. Children in counties with behavioral carve-outs under Medicaid managed care had lower odds of inpatient mental health service use. Medicaid managed care enrollment and variations in type of provider reimbursement did not affect use of mental health services. Older age, greater need for mental health services, and higher levels of caregiver education were associated with increased odds of service use. Restrictions on use of inpatient mental healthcare caused by behavioral carve-outs may disproportionately affect children in the child welfare system who have high rates of such use. Careful adoption of carve-outs is necessary to assure appropriate care for these children.     

Trade-Offs Between Formal Home Health Care and Informal Family CareGiving

Using 1994 National Long Term Care Survey data, we estimated logistic regressions of formal and informal home health care use and hours. Home health care use and intensity were differentially impacted by chronic conditions, are higher for Medicaid enrollees and rural or small town residents, but lower for HMO enrollees. Decreases in the probability of home health care use increased informal instrumental activities of daily living (IADL) support four hours and decreased informal activities of daily living (ADL) support eight hours weekly. IADL caregiving substituted for formal care, but ADL caregiving declined with reductions in formal care. Public policy reducing formal home health care access may reduce informal ADL caregiving and increase informal IADL caregiving, producing net declines in support.     

大学生英语学习心理问题探析

心理因素对学生的学习及生活起着举足轻重的作用。大学英语教师不仅应该从自身出发 ,提高业务水平 ,还应该考虑到学生的各种学习心理 ,及时有效地加以引导 ,使其有利于大学英语教学和学生的身心健康。     

Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.     

关于期刊编辑主体疲劳心理的理论分析

期刊编辑在产生疲劳心理时,要有正确的认识目的和正确的克服方法。本文以编辑心理学理论为根据,运用劳动生理和劳动心理的知识,对期刊编辑主体在编辑活动中的心理现象———产生疲劳、积累疲劳和恢复疲劳的一般规律进行了理论分析,旨在培养编辑的心理素质,合理设计编辑工作模式,提高编辑工作效率。     

社区卫生服务中心与医院手术费用的比较研究

目的:比较社区卫生服务中心及各级医院常见手术费用;社区卫生服务中心手术是否便捷、低耗,有无保留的必要。方法:调研南京市社区卫生服务中心及各级医院常见手术的单病种费用,社区卫生服务中心与各级医院的费用做统计分析比较。结果:社区卫生服务中心单病种手术平均住院费用明显低于与各级医院。结论:从经济学的角度分析,各级医院手术费用差别很大,在规范和安全的前提下,社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。     

福州市社区空巢老年人健康状况调查

目的了解空巢老年人的健康现状及其影响因素,为老龄工作提供科学依据。方法2002年4~5月进行入户调查,采用分层整群抽取福州市鼓楼、台江、仓山三个区60岁及以上的社区老年人,共得到有效样本1767例,其中空巢老人696名。空巢老人躯体健康、生活自理能力(ADL)、经济状况、精神健康、社会健康5个维度的健康状况及其影响因素的调查是本次研究的主要内容。结果福州市社区空巢老年人占老年人总体比例的39%,其中男性多于女性;由logistic检验得出空巢老年人健康状况受年龄、性别、原职业、是否赞成非家庭养老方式、锻炼程度等因素的影响。结论倡导空巢老年人形成良好的生活饮食习惯与自我保健意识,加强对空巢老年人慢性病的防治,丰富老年人的精神生活、社会生活,提高对空巢老年人经济支持,完善社区为老服务,从而改善空巢老年人的健康状况。     

从《诗经》看中原文化

《诗经》时代中原各诸侯国的地理位置及诗中所咏风物多数在目前尚存遗迹。《诗经》中作于中原之诗的文化内容,主要是:对祖先神灵崇拜的宗教文化;重视婚爱的民俗文化;追求人体美的文化心理。研究《诗经》时代中原文化具有重要意义:有助于重新认识文化的延续性;有助于明确认识地理环境与文化产生、发展的关系;有助于加深对中原文化乃至我国民族文化特点的认识。     

生态运动与绿色主义福利思想：生态健康科学与新型公共卫生框架

人与自然、社会与自然关系既是经典的理论议题,又是紧迫重大的现实政策问题.本文从生态运动入手,系统介绍作为生态运动理论基础的绿色福利主义,并以生态健康科学为基本理论视角,简要探讨新型现代公共卫生政策框架及其革命性的现实、理论与政策涵义.     

Medicine on the line? Computer‐mediated social support and advice for people with diabetes

The advent of thousands of Usenet groups on the Internet, covering a vast range of medical and welfare issues and ostensibly devoted to the mutual social support of participating members, has raised the potential for the development of new forms of 'virtual' health care. This article critically analyses the use by people with diabetes of one such Usenet group. It seeks to establish, first, the extent to which such a site provides some demonstrable measure of social support to its participants. This is approached by undertaking a structural analysis of the site to identify the extent of usage, and the nature of supporting interventions using a fivefold classification (instrumental, informational, esteem and social companionship and other). Second, the article attempts to identify any disparity between the lay health-knowledge in evidence and biomedical opinions proffered by the use of a panel of consultant diabetiologists. The results of the analysis suggest that the diabetes newsgroup provides an example of an active forum for largely well-informed participants who routinely use the media as an aid to the reflexive management of their medical condition. It also raises the prospect of a renegotiated relationship between medical knowledge and lay experience based upon shared learning