Mechanical Ventilation

The therapeutic alliance has been found to predict psychotherapy outcome in numerous studies. However, critics maintain that the therapeutic alliance is a by-product of prior symptomatic improvements. Moreover, almost all alliance research to date has used differences between patients in alliance as predictor of outcome, and results of such analyses do not necessarily mean that improving the alliance with a given patient will improve outcome (i.e., a within-patient effect). In a sample of 646 patients (76% women, 24% men) in primary care psychotherapy, the effect of working alliance on next session symptom level was analyzed using multilevel models. The Clinical Outcomes in Routine Evaluation–Outcome Measure was used to measure symptom level, and the patient version of the Working Alliance Inventory–Short form revised (Hatcher & Gillaspy, 2006) was used to measure alliance. There was evidence for a reciprocal causal model, in which the alliance predicted subsequent change in symptoms while prior symptom change also affected the alliance. The alliance effect varied considerably between patients. This variation was partially explained by patients with personality problems showing stronger alliance effect. These results indicate that the alliance is not just a by-product of prior symptomatic improvements, even though improvement in symptoms is likely to enhance the alliance. Results also point to the importance of therapists paying attention to ruptures and repair of the therapy alliance. Generalization of results may be limited to relatively brief primary care psychotherapy

Progress in Hemodialysis

Hemodialysis (HD) represents the first successful long-term substitutive therapy with an artificial organ for severe failure of a vital organ. Because HD was started many decades ago, a book on HD may not appear to be up-to-date. Indeed, HD covers many basic and clinical aspects and this book reflects the rapid expansion of new and controversial aspects either in the biotechnological or in the clinical field. This book revises new technologies and therapeutic options to improve dialysis treatment of uremic patients. This book consists of three parts: modeling, methods and technique, prognosis and complications

Pseudo National Security System of Health in Indonesia

ABstRACt Adolescence is a crucial period where one tends to identify who they are as an individual. However, as a teenager is struggling to find his/her place in this world, it is also a time where they are prone to engaging in risk behaviors, which tend to have an extreme psychological impact. The objective was to explore the experiences of an adolescent who engages in risk behaviors and to understand their level of personal fables. The study was a qualitative design with content analysis with semi-structured interviews of ten male adolescents aged 16-18 years. The major findings of the study indicated that adolescent’s pattern of thinking revolves around the fact that they are invincible and invulnerable. Furthermore, adolescents are aware of the risks they are putting themselves through and how in the process they are hurting others. The implications of the study are to conduct more life skill programs in schools; greater awareness has to be created on the impact and harmful effects of such behaviors

Policy Implementation Analysis of District Health System to Improve Health Services: Study in North Central Timor Regency, East Nusa Tenggara Timur Province, Indonesis

Context: Improving degree of public health in a region requires quality health services. For this reason, district health system has been formed which can be implemented comprehensively to the target community. A study is needed to find out the factors that influence policy implementation so that quality of health services can be improved. This study used quantitative method with structural equation models to find patterns of the relationship between the district health system and health services. The results showed that there are 7 indicators that are part of the district health system factors, 2 indicators that are part of the resposivensss factor, 8 indicators that are part of the policy implementation factor, and 3 indicators that are part of the health service factor. These indicators have loading factor ≥ 0.5. The district health system consisting of 7 subsystems if properly implemented will have a positive impact on health services by 1.98. Contribution of policy implementation in improving health services will be great if the district health system is implemented together with responsiveness, so that the total effect becomes 2.20