Valuing mother and child health: The intrauterine environment

The paper estimates the value a mother assigns to own health relative to child health. Estimation of relative health valuation requires the decomposition of a child health improvement into its direct effect on the child's health and its indirect effect, through improvements in maternal health. Failure to distinguish the impact of the direct and indirect effects can lead to biased estimates. We consider the intrauterine environment of a pregnant mother and her unborn child, where maternal health inputs are choice variables and her health affects child health. The empirical estimates suggest that mothers value child health up to six times higher than own health, and that the relative value depends on maternal consumption patterns and household characteristics.     

Challenges and Opportunities: What Can We Learn from Patients Living with Chronic Musculoskeletal Conditions,Health Professionals and Carers about the Concept of Health Literacy Using Qualitative Methods of Inquiry?

The field of health literacy continues to evolve and concern public health researchers and yet remains a largely overlooked concept elsewhere in the healthcare system. We conducted focus group discussions in England UK, about the concept of health literacy with older patients with chronic musculoskeletal conditions (mean age  = 73.4 years), carers and health professionals. Our research posed methodological, intellectual and practical challenges. Gaps in conceptualisation and expectations were revealed, reiterating deficiencies in predominant models for understanding health literacy and methodological shortcomings of using focus groups in qualitative research for this topic. Building on this unique insight into what the concept of health literacy meant to participants, we present analysis of our findings on factors perceived to foster and inhibit health literacy and on the issue of responsibility in health literacy. Patients saw health literacy as a result of an inconsistent interactive process and the implications as wide ranging; healthcare professionals had more heterogeneous views. All focus group discussants agreed that health literacy most benefited from good inter-personal communication and partnership. By proposing a needs-based approach to health literacy we offer an alternative way of conceptualising health literacy to help improve the health of older people with chronic conditions.     

Quantitative impact of mental health preparedness training for public health professionals

Coordinating and integrating mental health topics into emergency preparedness planning is a critical step for ensuring effective response to the psychological issues connected with trauma. In order to remedy the current lack of integration, potential response providers must receive effective mental health preparedness training. The current study provided mental health preparedness training to public health and allied health professionals in Kansas and assessed the impact of the training on perceived mental health preparedness knowledge. Participants included 157 potential first and secondary responders from public health and allied fields who attended one of 10 training presentations on mental health emergency preparedness. Pre- and post-presentation, participants responded to six Likert-scale questions about their perceived knowledge of topics and level of mental health preparedness. Questions addressed common psychological responses to disaster or terrorist events, stress reactions of specific populations, psychological resiliency, mental health preparedness integration, and level of agency preparedness. Post-training, participants reported statistically significant (p<0.001) increases in perceived level of knowledge on all topics. Participants were also significantly more likely (p<0.001) to report that their agency could respond to the mental health issues related to a disaster or emergency. The current study provides data about gaps in practitioner knowledge regarding mental health preparedness in Kansas. While the self-report nature of responses is a limitation, these findings serve as the first step toward producing and implementing effective mental health preparedness information and training on a wide scale.     

森林生态系统健康评估I．模式、计算方法和指标体系

生态系统健康评估是21世纪生态系统学研究的主要内容和迫切任务之一．简单实用的生态系统健康评估理论和方法需要可操作性的概念和一个全面、简明、易操作且规范化的指标体系,它们是进行生态系统健康评估的基础．以阔叶红松林生态系统为例,从对森林生态系统健康的理解和评价出发。通过引入模式生态系统集的思想,提出了对森林生态系统健康理解的独创看法,并以此提出生态系统健康评估的新方法——健康距离(HD)法,并推导出计算公式．同时,针对阔叶红松林生态系统的系统特征和面临的各种具体健康问题,提出了基于自然-经济-社会复合生态系统属性的阔叶红松林生态系统健康评估指标体系,并具体到各度量指标,为下一步的健康评估打下基础．     

Fair Resource Allocation to Health Research: Priority Topics for Bioethics Scholarship

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non‐domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision‐making on whether and to what extent to allocate resources to non‐domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny.     

Public health 2020.

The aim of public health is to improve the health of people in communities and in populations (protection from environmental hazards and provision for health needs). The challenge for public health doctors is to re-establish public health leadership of communities, address social and environmental causes of ill health, and link with primary care (a) to improve the health of neighbourhoods and (b) to combine perspectives in commissioning services. Current threats derive from organisational philosophies. For example, focusing on market development does not allow for population based functions and so neglects the main influences on health. The way forward is a network model of organisation in which small teams collaborate with each other to the common good. For example, successful commissioning authorities would have the public health leadership of the director of public health and the support of the chief executive, treasurer, and representatives of primary care, including a medical adviser from the family health services authority.     

Digital transformation: The role of computer use in employee health

This paper studies employee health in the context of digital transformation in Germany. While most studies have focused on mental health, we focus on physical health. Using pooled survey data, we estimate how an increased use of computers in the workplace relates to subjective health and work-related health complaints. We find that employees using the computer frequently report better subjective health and a significantly lower prevalence of back pain and physical exhaustion. After controlling for physical work exposures, the health-promoting effect of computer use is much smaller, suggesting that high computer use is associated with a less physically demanding work environment, which in turn relates to better (physical) health outcomes. While digital transformation seems to foster physical health, there are hints that mental health could deteriorate. Thus, the focus of occupational health is shifting towards the prevention of mental stress.     

生态系统健康研究进展

健康的生态系统一般被视为环境管理的终极目标,进行生态系统健康研究对探索区域与生态系统可持续发展具有重要意义。随着国际生态与健康学会(International Association for Ecology and Health)的解体,生态系统健康研究视角出现转型。系统梳理了近年来国际上有关生态系统健康概念及其评估方法、指标的新进展,通过文献统计和重要文献引用揭示了国际生态系统健康研究的发展历程,提出了从生态系统健康到生态健康再到生态文化健康的三大核心框架发展阶段,生态系统健康的研究对象和范围正在不断扩充。资源环境研究领域是国内研究者应用生态系统健康概念与方法的优势领域,在区域尺度上评价生态系统的健康更贴近资源环境和社会文化交互作用的复合表征理念。因此,我国生态系统健康研究的趋向不仅应包括在生态系统尺度上研究的继续深化,也应包含对生态文化健康概念的完善与应用,并发挥地理-生态视角的区域集成研究优势,从而有效指导区域生态与环境政策制定与实施。     

区域生态系统健康评价——研究方法与进展

生态系统健康评价是当前宏观生态学与生态系统管理研究的热点问题之一,区域尺度的生态系统健康评价则是生态系统健康评价研究的一个重要发展方向。在探讨生态系统健康时空尺度特征的基础上,明确界定了区域生态系统健康及其评价等相关概念,结合目前区域尺度生态系统健康评价的相关研究进展,从评价的区域类型、目标单元、模型方法、指标选取及其阈值、权重设定等方面探讨了区域生态系统健康评价的基本原理与方法,并展望了进一步研究的重点方向,即评价结果的多尺度综合与尺度转换、景观生态学理论与方法的应用、3S技术的综合应用等理论与技术问题。     

Distribution of mental health professionals working on site in English and Welsh general practices.

OBJECTIVE--To describe the nature and distribution of mental health professionals working on site in general practices. DESIGN--Postal questionnaire and telephone interview survey. SETTING--English and Welsh general practices. SUBJECTS--1880 general practitioners, of whom 1542 (82%) responded. MAIN OUTCOME MEASURES--Prevalence, types, and distribution of mental health professionals working on site among general practices. Factors predicting the presence of mental health professionals on site. RESULTS--The number of practices reporting the presence on site of each type of professional were 528 for community psychiatric nurses; 266 for practice counsellors; 177 for clinical psychologists; 132 for psychiatrists; 96 for psychiatric social workers; and 45 for psychotherapists. Mental health professionals tended to cluster together in practices more often than expected by chance alone. Practice characteristics which independently predicted the presence of a mental health professional on site were having four or more partners; being a training practice; and running stress, bereavement, or other mental health clinics. The proportions of practices with mental health professionals on site varied significantly among health regions. There was no association between the presence of mental health professionals on site and the location of practices, the social class mix of patients, or the estimated percentage of elderly patients or patients of non-European origin. CONCLUSIONS--Mental health professionals tend to cluster together, with a preponderance in larger training practices. Specialist mental health care provision within general practices is unevenly distributed. Further research is needed to determine whether this uneven distribution reflects differences in need or inequalities in the provision of mental health services.     

Social determinants of health--a comparative study of Bosnian adolescents in different cultural contexts

This study investigated the effects of sociocultural contexts on health and the psychological well-being of immigrant adolescents, aged 15 to 18 years, originally from Bosnia and Herzegovina and now living as displaced persons either in Bosnia, or immigrants in Croatia and Austria. The study addresses the social determinants of health with a specific focus on five factors in the social environment that might have an influence on health status: gender, socio-economic status (SES), perceived discrimination and exposure to violence, social support and religious commitment. Dependent variables included self-rated health, a count of self-reported objective health problems and a range of indices of psychological well-being (somatic stress, anxiety, depression and self-esteem). The purpose of the study was to examine whether social risk factors have an effect on health, which factors mediate these effects on self-rated health and to assess whether these effects differ by gender Results indicate that perceived discrimination and violence are related to poor health through psychological stress as a major mechanism with stronger effects for girls in the study. Differences across the three socio-cultural contexts reveal the complexity and specificity of the relationships between analyzed factors as the association between discrimination and health was attenuated for some groups due to the protective resources of immigrants.     

From “Shrinks” to “Urban Shamans”: Argentine Immigrants’ Therapeutic Eclecticism in New York City

This article examines Argentine immigrants' reliance on informal networks of care that enable their access to a variety of health providers in New York City (NYC). These providers range from health brokers (doctors known on a personal basis) to urban shamans, including folk healers and fortunetellers of various disciplines. A conceptual framework, based on analysis of social capital categories, is proposed for the examination of immigrants' access to valuable health resources, which are based on relationships of reciprocity and trust among parties. Results revealed immigrants' diverse patterns of health-seeking practices, most importantly their reliance on health brokers, epitomized by Argentine and Latino doctors who provide informal health assistance on the basis of sharing immigrants' social fields and ethnic interests. While mental health providers constitute a health resource shared by Argentines' social webs, urban shamans represent a trigger for the activation of women's emotional support webs. Contrary to the familiar assumption that dense and homogenous networks are more beneficial to their members, this article underscores the advantages of heterogeneous and fluid social webs that connect immigrants to a variety of resources, including referrals to diverse health practitioners.     

Threshold considerations in fair allocation of health resources: justice beyond scarcity

Application of egalitarian and prioritarian accounts of health resource allocation in low-income countries have both been criticized for implying distribution outcomes that allow decreasing/undermining health gains and for tolerating unacceptable standards of health care and health status that result from such allocation schemes. Insufficient health care and severe deprivation of health resources are difficult to accept even when justified by aggregative efficiency or legitimized by fair deliberative process in pursuing equality and priority oriented outcomes. I affirm the sufficientarian argument that, given extreme scarcity of public health resources in low-income countries, neither health status equality between populations nor priority for the worse off is normatively adequate. Nevertheless, the threshold norm alone need not be the sole consideration when a country's total health budget is extremely scarce. Threshold considerations are necessary in developing a theory of fair distribution of health resources that is sensitive to the lexically prior norm of sufficiency. Based on the intuition that shares must not be taken away from those who barely achieve a minimal level of health, I argue that assessments based on standards of minimal physical/mental health must be developed to evaluate the sufficiency of the total resources of health systems in low-income countries prior to pursuing equality, priority, and efficiency based resource allocation. I also begin to examine how threshold sensitive health resource assessment could be used in the Philippines.     

Evaluation for regional ecosystem health: methodology and research progress

The evaluation for ecosystem health is one of the hotspots in the fields of macro-ecology and ecosystem management. Conducting analysis at the regional scale is an important direction for evaluating ecosystem health. Changing the spatial scale from the local to the regional level leads to great differences in targets and methodologies for ecosystem health evaluation and creates a new direction for regional ecosystem health research. Compared with the ecosystem health at the local scale, which refers to a single ecosystem type, the regional ecosystem health focuses on the health conditions and spatial patterns of different ecosystem types. However, there has been little attention paid to this very research up to now. Based on the progress on ecosystem health studies at the regional scale, the study reported in this article aims to discuss the implications of the conception of regional ecosystem health and to put forward a methodology for evaluating the regional ecosystem health. The main results include: (1) there is a significant scaling effect on the ecosystem health analysis, and the regional level is the key scale used to focus on the correlation between spatially neighboring ecosystems in terms of ecosystem health; (2) regional ecosystem health can be defined through 4 aspects, i.e., vigor, organization, resilience, and ecosystem service functions; (3) the basic evaluation objects of the regional ecosystem health is spatial entity, which is the matrix of different ecosystem types; (4) indicator system method is the only approach to evaluate regional ecosystem health; (5) the absolute thresholds of the evaluation indicators for the regional ecosystem health do not exist; the aim of the evaluation is to discuss the temporal dynamic changes and spatial differences of health conditions rather than to ascertain whether a region is healthy or not in view of ecological sustainability; and (6) the integration of evaluation results at multispatial scales, the application of this methodology in the landscape ecology, and the utilization of geographic information systems (GIS), remote sensing (RS), and Global Positioning Systems (GPS) technologies are the main directions for further research.     

浅谈高校心理健康教育工作体系的构建与完善

当前,高校心理健康教育已成为构建社会主义和谐社会的重要内容,构建和谐校园的重要途径。构建高校心理健康教育工作体系对加强和改进高校心理健康教育具有十分重要的意义,必须通过重视心理教育、完善心理援助、优化心理环境、提升支持保障等方面来构建心理健康教育工作体系,通过以教育为根本、以发展为主线、以建设为重点来完善心理健康教育工作体系。     

Does Consideration and Assessment of Effects on Health Equity Affect the Conclusions of Systematic Reviews? A Methodology Study

Introduction

Tackling health inequities both within and between countries remains high on the agenda of international organizations including the World Health Organization and local, regional and national governments. Systematic reviews can be a useful tool to assess effects on equity in health status because they include studies conducted in a variety of settings and populations. This study aims to describe the extent to which the impacts of health interventions on equity in health status are considered in systematic reviews, describe methods used, and assess the implications of their equity related findings for policy, practice and research.

Methods

We conducted a methodology study of equity assessment in systematic reviews. Two independent reviewers extracted information on the reporting and analysis of impacts of health interventions on equity in health status in a group of 300 systematic reviews collected from all systematic reviews indexed in one month of MEDLINE, using a pre-tested data collection form. Any differences in data extraction were resolved by discussion.

Results

Of the 300 systematic reviews, 224 assessed the effectiveness of interventions on health outcomes. Of these 224 reviews, 29 systematic reviews assessed effects on equity in health status using subgroup analysis or targeted analyses of vulnerable populations. Of these, seven conducted subgroup analyses related to health equity which were reported in insufficient detail to judge their credibility. Of these 29 reviews, 18 described implications for policy and practice based on assessment of effects on health equity.

Conclusion

The quality and completeness of reporting should be enhanced as a priority, because without this policymakers and practitioners will continue lack the evidence base they need to inform decision-making about health inequity. Furthermore, there is a need to develop methods to systematically consider impacts on equity in health status that is currently lacking in systematic reviews.     

Focus: Preventive Medicine: Leveraging Organizational Health Literacy to Enhance Health Promotion and Risk Prevention: A Narrative and Interpretive Literature Review

Organizational health literacy involves the health care organizations’ ability to establish an empowering and co-creating relationship with patients, engaging them in the design and delivery of health services in collaboration with health professionals. Although scholars agree that organizational health literacy contributes to health promotion and risk prevention via patient empowerment, literature is not consistent in depicting the interplay between organizational health literacy and preventive medicine. The article intends to shed light into this issue, summarizing current knowledge about this topic and advancing avenues for further development. A narrative literature review was performed through a systematic search on PubMed^®, Scopus^®, and Web of Science^™. The review focused on 50 relevant contributions. Organizational health literacy triggers the transition towards a patient-centered approach to care. It complements individual health literacy, enabling patients to actively participate in health promotion and risk prevention as co-producers of health services and co-creators of value. However, many obstacles – including lack of time and limited resources available – prevent the transition towards health literate health care organizations. Two initiatives are required to overcome extant barriers. On the one hand, a health literate workforce should be prepared to increase the institutional ability of health care organizations to empower and engage patients in health co-creation. On the other hand, increased efforts should be made to assess organizational health literacy and to make its contribution to preventive medicine explicit.