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PubMed1990

Major mental illness, housing, and supports. The promise of community integration.

Providing housing and supports for people with psychiatric disabilities, particularly those who are homeless, is a major public policy challenge. This article summarizes the ways in which the concept of these needs is rapidly shifting in the mental health field. The article is based on research on the effectiveness of non-facility-based community support and rehabilitation approaches, the findings of other disability fields, and the emergence of mental health consumers' own preferences for expanded choices, normal housing, and more responsive services, including consumer-operated services. These new sources of knowledge are facilitating a paradigm shift in which people with psychiatric disabilities are no longer seen as hopeless, or merely as service recipients, but rather as citizens with a capacity for full community participation and integration.

Community Mental Health Services↗
PubMed1993

Condom use: a self-efficacy model.

A survey of heterosexually active college students gathered information about condom use, self-efficacy (SE), outcome expectancies, sexual attitudes, peer group influences, acquired immunodeficiency syndrome (AIDS) knowledge, and perceived vulnerability to AIDS. On the basis of A. Bandura's (1986) social-cognitive theory, a structural model with SE as the central mediator was formulated and evaluated with LISREL. This model explained 46% of the variance in condom use from judgments of SE and effects attributable to peers and 53% of the variance in SE from outcome expectancies and peer group influences. Sexual attitudes, AIDS knowledge, and perceived vulnerability did not predict condom use. Most students were well-informed about human immunodeficiency virus (HIV) transmission but reported not feeling at risk, even though many engaged in risky sexual behavior.

Acquired Immunodeficiency Syndrome↗
PubMed1977

A comparison between John Dewey's theory of inquiry and Jean Piaget's genetic analysis of intelligence.

This article compares John Dewey's theory of inquiry with Jean Piaget's analysis of the mechanisms implied in the increase of knowledge. The sources for this paper are Dewey's studies on logic and the theory of inquiry and Piaget's historical-critical and psychogenetic investigations. Three major conclusions result from the comparison: first, there are significant convergences between the two theories; second, Piaget's developmental analysis makes explicit what is programmatic in Dewey's investigations; and, finally, Piaget is incorrect in characterizing Dewey's pragmatism as a method that does not meet the criteria of intelligent activity.

Adaptation, Biological↗
PubMed1992

AIDS, sex and condoms: African healers and the reinvention of tradition in Zaire.

Condoms offer considerable protection against sexual transmission of AIDS. Yet many Africans who are at risk of infection reject condoms as "unnatural." Data from Zaire have been used to examine this culturally constructed category in relation to sexuality, procreation, gender roles, class formation and international health and development policy. Much more than a simple transfer of biomedical technology is involved. Condom use with regular partners raises issues of cultural politics at many levels. "Traditional" African healers represent important social networks with considerable authority in poor urban communities. They are able to reinterpret cultural categories and endow behavior with new meanings. Action-research in Kinshasa was used to explore roles that healers might play in promoting change to safer sex practices.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The home birth movement in the United States.

The home birth movement in the United States is an alternative health belief system that promotes a model of pregnancy and childbirth contradictory to the conventional biomedical model. The alternative model stresses normalcy and non-intervention and is informed by an ideology that promotes individual authority and responsibility for health and health care. It is founded in an epistemological system that assigns primacy and goodness to the Natural, fuses moral and practical injunctions in the arena of health behavior, and valorizes subjective as well as objective sources of knowledge. (Natural = as found in nature without technical intervention). Differences of opinion with the conventional medical model of childbirth do not spring from misunderstanding of this model, but from disagreement with it. Members of this movement are typically educated, middle class, and white.

Delivery of Health Care↗
PubMed1983

What kind of expert should a system be?

Human experts are the source of knowledge required to develop computer systems that perform at an expert level. Human beings are not, however, able to reliably express what they know. As a result, experts often develop non-authentic accounts of their own expertise. These accounts, here termed reconstructed methods of reasoning, lead to computer systems that perform at a high level of proficiency but have the disadvantage that they often do not reflect the heuristics and processing constraints of a system user. Reconstructed methods of reasoning are compared with authentic methods derived from the study of expert human behavior. Tests are proposed to establish the authenticity of reasoning methods and examples from medical diagnosis are used to illustrate how authentic methods of reasoning can be incorporated into an expert computer system.

Clinical Competence↗
PubMed1988

Substance use by fourth-year students at 13 U.S. medical schools.

Fourth-year medical students at 13 medical schools in different regions of the United States received an anonymous questionnaire designed to examine their current and prior use of 11 substances and their attitudes toward substance use among physicians. Of 1,427 questionnaires distributed, 41 percent were returned. The questionnaire and distribution method were derived from an ongoing survey on drug use in order to permit comparison of the medical students with a national sample of age- and sex-matched cohorts. The rates of substance use during the 30 days preceding receipt of the questionnaire were: alcohol, 87.8 percent; marijuana, 17.3 percent; cigarettes, 9.0 percent; cocaine, 5.6 percent; heroin, 0.0 percent; other opiates, 0.9 percent; LSD, 0.2 percent; other psychedelics, 0.5 percent; barbiturates, 0.5 percent; tranquilizers, 2.2 percent; and amphetamines, 1.2 percent. Compared with their age and sex cohorts nationally, the medical students reported less use of marijuana, cocaine, cigarettes, LSD, barbiturates, and amphetamines. However, their use of other opiates was approximately the same and their use of tranquilizers and alcohol was slightly higher than that of the other cohorts. Data on their sources of knowledge about drug abuse indicate the need for greater attention to this issue in the medical curriculum.

Adult↗
PubMed1994

Evaluation of a targeted AIDS prevention intervention to increase condom use among prostitutes in Ghana.

OBJECTIVE: To assess the short- and long-term impact of a 6-month pilot intervention program on condom use among prostitutes in Accra, Ghana. DESIGN: The 4-year prospective study follows-up cohorts enrolled in the intervention in 1987 and 1988, comparing condom use in 1991 with that among a comparison group not enrolled in the intervention. SETTING: The community-based intervention was initiated in Accra, Ghana in 1987. PARTICIPANTS: Self-identified female prostitutes who volunteered participation. INTERVENTION: The educational intervention used local health workers to train and support selected prostitutes to be health educators and condom distributors to their peers. OUTCOME MEASURES: Self-reported condom use with clients. RESULTS: Reported condom use increased dramatically between 1987 and 1988 during the first 6 months of the intervention. In 1991, after 3 years of program relapse, 107 (43%) of the 248 women who had enrolled in 1987 or 1988 were still in prostitution and located for interview. Their level of condom use in 1991 was higher than pre-enrollment but similar to use among prostitutes never enrolled. Sixty-four per cent of those followed-up reported always using condoms with clients in 1991. These 'always users' were more likely to have maintained informal contact with project staff, know that HIV can be transmitted by healthy clients, and report that clients frequently initiate condom use. CONCLUSIONS: Findings support the development of long-range educational strategies that recognize the career longevity of prostitutes, available channels for informal program diffusion, individual changes in condom use over time, and the role of clients in condom negotiation.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Pregnancy risk among the younger sisters of pregnant and childbearing adolescents.

There is increasing evidence that younger sisters of childbearing teenagers are at increased risk for adolescent childbearing. We critically review this research and discuss three plausible theoretical explanations (social modeling, shared parenting influences, and shared societal risk) why the younger sisters of childbearing adolescents would themselves be at risk for teenage pregnancy. Considerations for preventive interventions aimed at the younger sisters of pregnant teenagers and directions for future research are discussed.

Adolescent↗
PubMedDate not supplied

Community influences on breast feeding.

The incidence of breast feeding in Camden and Paddington is reported for two periods, 1974-75 and 1976-77. In 1976 a programme was begun to encourage breast feeding by increasing contact and support by the health visitor and child health visitor and child health clinic antenatally and postnatally. Fifty-eight per cent of mothers in Camden and 56% of mothers in Paddington breast fed at 3 weeks in 1976-77 compared with 24% (Camden) and 20% (Paddington) in 1974-75. The incidence of breast feeding in the experimental areas was compared with that in a similar control area in which no intervention occurred to investigate whether this increase reflected a widespread increase in the popularity of breast feeding or resulted from intervention. In 1976-77 more mothers in the experimental, than in the control area who breast fed on discharge continued to do so during the first 5 months. Of the mothers who were discharged breast feeding 88% in Camden and 73% in Paddington compared with 57% in the control area were still doing so at 6 weeks. The pattern of home visiting by the health visitors and attendance at the child health clinic was also investigated. More antenatal and postnatal home visits, more clinic visits and earlier home visits took place in the experimental areas compared with the control area. We conclude that the health visitor and child health clinic have an important role to play in the management of lactation.

Breast Feeding↗
PubMedDate not supplied

Pregnancy and antenatal care: the attitudes and experiences of Asian women.

Asian women living in the East End of London were interviewed in English or in their own language to assess their attitudes to and experiences of pregnancy and antenatal care and to consider some factors which may influence their experiences, especially their fluency in English. In some respects Asian women's experiences were similar to those of non-Asian women reported in other studies, e.g. similar levels of nausea and lack of tie-up between nausea and negative reactions to pregnancy. However there were also some differences, e.g. Asian women expressed greater concern about the sex of the child and about eating 'cool' foods to counterbalance the hot state of pregnancy. Asian women were good patients: they attended antenatal clinics, read the leaflets provided and about half attended antenatal classes, although some were keener than others to seek information about pregnancy and childbirth and only a quarter bought books or watched videos. Less than half of the women were living in extended families and receiving support from in-laws in the traditional way. Those living in nuclear families received support from friends, neighbours and especially husbands. There were considerable individual differences in women's reactions and experiences. Women who spoke little or no English were less knowledgeable and had lived for a shorter time in the UK than women who were fluent in English. Leaflets in languages women can read and link workers at clinics helped some women.

Acculturation↗
PubMed1992

Effects of communication with important social referents on beliefs and intentions to use condoms.

Data from a 1989 survey using the condom attitude and belief instrument with 310 clients from two sexually transmitted disease clinics identified significant social referents who influence condom-use intentions. They are sexual partner, father and friends. The present study found that communication with these referents had a positive net effect on beliefs about and intentions to use condoms. Implications applicable for intervention programmes to increase condom use are to promote talking about condoms between the sexual partners and important social referents and to develop such communication skills.

Adolescent↗
PubMed1983

Medical education: views and opinions of teachers and students at the University of Athens.

Athens University teachers' and students' views and opinions on general issues in medical education were recorded by the method of written questionnaires. This was undertaken in an attempt to have basic material necessary for possible reform of the present system. Eleven professors, fifty associate professors, eighty-three lecturers, 107 assistants, sixty final-year students and eighteen teachers, who had just finished a course in educational techniques, responded to the thirty-six items of a Greek-oriented questionnaire especially prepared for this purpose. Results were analysed and presented in topics such as evaluation, students' characteristics, ways of training, and characteristics of the effective university teacher. Commonly accepted issues were: frequent examinations; repeated orientation and guidance of students; examination to evaluate both students and teachers; smaller group tutorial teaching; student participation in curriculum planning; lesser factual details; teaching how to search into the sources of knowledge; inspiration of life learning. It is concluded that there are several key issues shared in common among both senior and junior teachers and students. Reform which is desirable can thus be widely accepted.

Attitude of Health Personnel↗