Moving toward recovery within clients' personal narratives: directions for a recovery-focused therapy

Recent literature emphasizes that recovery from schizophrenia involves recovery within one's own narrative of an integral sense of identity, agency, social connection, and worth. While this is intuitively appealing and consistent with a wide range of literature, it raises the issue of how to best help people do this in individual psychotherapy. In this article, we explore how psychotherapy might help people construct new narratives or storied understandings of their lives and thereby promote recovery from schizophrenia. Exemplified with two individual examples, we first discuss the barriers that challenge and the techniques that help psychotherapists seeking to enter into dialogue with people with severe mental illness. We also offer a theoretical model of how the revitalization of dialogues within therapy can be conceptualized as a process that promotes recovery and discuss the objective measurement of such outcomes.     

Clinical effects of growth hormone on bone: a review

Growth hormone (GH) stimulates bone turnover. Deficiency of GH due to hypopituitarism is related to low bone mineral density and increased fracture risk. GH substitution increases and thus normalizes bone mineral density in these patients, which is one of a number of arguments for GH substitution in hypopituitarism. In contrast, a possible therapeutic use of GH in idiopathic osteoporosis and glucocorticoid-induced osteoporosis is speculative and not established. Reduction of osteoporosis risk is an argument brought up for a use of GH in healthy elderly persons (anti-aging medicine). However, since only very limited data are available yet, this cannot be based on scientific evidence, and there are important concerns about the safety of use of GH in healthy elderly persons.     

从全球人口百年(1950～2050)审视我国人口国策的抉择

基于“人口众多”这一基本国情,我国自20世纪80年代前后采取了严格控制人口增长的政策。对于这一政策应科学、全面地衡量其利害得失。文章利用全球人口资料和我国历次人口普查及人口预测资料,从人口规模、结构的发展变化作实证研究。最终认为,我国的人口国策是利大于弊。     

A Study of An Alternative School for Pregnant and/or Parenting Teens: Quantitative and Qualitative Evidence

In response to multiple problems faced by pregnant and parenting teens, many alternative school-based comprehensive programs have been established throughout the United States. By collecting data from a sample of enrollees of such a school-based comprehensive program and comparing them with data collected from a sample of non-enrollees, the present study systematically evaluates the program. The results of the study seem to suggest that the program participants were more likely to have higher educational aspiration, better reproductive health outcomes, higher contraceptive use, and more breast-feeding practice and intention than those of their non-participating counterparts. The implications of the study findings for comprehensive school-based program for pregnant and/or parenting teens are discussed.Ruhul Amin is a Senior Fellow at the Center for Health Disparities Solutions and Senior Research Scientist in the Institute for Urban Research, Morgan State University, Baltimore, MD 21239. Dorothy C. Browne is the Director of the Institute for Urban Research, Jamir Ahmed is a research assistant at the Center for Health Disparities Solutions and Takanori Sato is research assistants at the Institute for Urban Research, Morgan State University, Baltimore, MD 21239.     

Illness and the disruption of autobiography: accounting for the complex effect of awareness in schizophrenia

Interventions for individuals with schizophrenia often involve helping clients become more aware of their condition so they can make informed decisions about their treatment and recovery. Yet the effect of awareness or admission of schizophrenia has remained elusive. Empirical research has found that awareness of illness is essential for people to make informed decisions about the future, to free themselves from blame for difficulties linked with illness, and to form and sustain bonds with others. However, this awareness has also been linked to depressed mood, lower self-esteem, and a diminished sense of well-being. In this article, we review the evidence and suggest that the effect of awareness on well-being may be mitigated by the meaning clients assign to their illness and whether it disrupts their life story. Evidence linking clients' internalized, stigmatizing beliefs about illness with demoralization is presented, and clinical implications are discussed.     

Patients' Evaluations of Gynecologic Services Provided by Nurse Practitioners

Abstract

The development, operating principles, and users' evaluations of a broad-based gynecologic program emphasizing effective birth control on a university campus are discussed. A major feature that is explored is the use of nurse practitioners as the primary service providers. The forces that resulted in the formation of the program and the methods used to enhance its effectiveness are described. The evaluations of 3,527 users over a three-year period are indicated by summarizing responses to a questionnaire covering the following topics; whether providing such a service was helpful, likelihood of arranging for the service elsewhere if unavailable at the health center, attitudes of staff, medical procedures used, availability of services, and the opportunity to thoroughly discuss concerns. The evaluations were seen as extremely supportive of both the program and the use of nurse practitioners in this setting.     

The Recovery Approach to Rehabilitation: Implementation in Supervision

The recovery approach to psychiatric rehabilitation has introduced a new set of challenges, enabling consumers to set goals and redefine their role in obtaining them. This has revolutionized the management of the relationship between service providers and consumers. In the present paper, we suggest that one of the important ways to supervise professionals interested in internalizing the recovery approach is to implement its major principles in the supervision work itself. The paper draws on intersubjective therapy concepts and guiding principles, which emphasize the development of the professional–consumer relationship in which the consumers' sense of agency can be respected and promoted. The principles we suggest here which may underlie supervision are: (1) clients or supervisees, with their own decisions and interests, are at the center of the rehabilitation therapy and supervision; (2) mutuality in the rehabilitative/supervisory relationship and ongoing discussion of the interactants' power and authority; and (3) the promotion of positive and empowering narratives and self-perceptions in the process of rehabilitation/supervision.     

Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting

Abstract

Patient satisfaction with health care services is an important factor in health care delivery. It will significantly influence whether or not a patient seeks medical care, complies with prescribed treatment, and/or maintains a continuing relationship with a medical practitioner.

A survey questionnaire, relating patient satisfaction with a number of variables identified through a literature review, was mailed to a random sample of 500 students utilizing Student Health Service (SHS) at Kent State University (KSU) during the five week study period. The data obtained would be utilized to help with planning future health care services and staff inservice education programs.

The findings of this survey indicate that patient satisfaction has a statistically significant correlation with perceived technical competence of the practitioner and perceived adequacy of the interpersonal aspects of the practitioner-patient relationship. A significant relationship did not exist between satisfaction and expectations the patient holds of the practitioner's role performance. A statistically significant relationship was found to exist between receiving health information/education related to diagnosis, prognosis, and treatment plan and satisfaction with health care services. This relationship did not hold for health information/education related to activity restrictions or preventive measures. The study also revealed that time waited during the medical care encounter was inversely related to satisfaction. Last, stepwise regression found that perceived technical competence of the practitioner was the most important variable influencing patient satisfaction with health care services.

This study provides data about factors important to personal satisfaction with health care services for a selected group of college students.