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Help-seeking for alcohol-related problems: social contexts surrounding entry into alcoholism treatment or Alcoholics Anonymous.

OBJECTIVE: The role of problem drinkers' social contexts in help-seeking patterns was investigated using recent entrants into outpatient alcoholism treatment or Alcoholics Anonymous (AA). Untreated, active problem drinkers served as controls. METHOD: Subjects (N = 45, with 15 per group: 62% male) were recruited from the community. Habitual drinking practices, social network characteristics, social support, help-seeking barriers and incentives, and event occurrences during the 2 years prior to help-seeking were assessed during structured interviews. Collaterals verified subject reports. RESULTS: Alcohol-related psychosocial problems and social network characteristics specific to drinking and help-seeking differentiated the groups, whereas drinking practices, general measures of social support and event occurrences did not. Both groups who sought help reported less network encouragement to drink, more network encouragement to seek help and greater alcohol-related psychosocial problems compared to untreated problem drinkers. AA participants also received more conflicting messages about seeking help than did treatment participants, and features of AA variously attracted and repelled different problem drinkers. CONCLUSIONS: The findings indicate the importance of separating alcohol-specific social influences on help-seeking from more general social contextual variables and provide a social basis for distinguishing the appeal of AA from that of formal treatment. The results generally concur with studies of help-seeking for other medical and psychological disorders and support a common approach that emphasizes the social nature of help-seeking and focuses on functional rather than structural influences.

Adult↗

Social problem solving training: a follow-up study of cognitive and behavioral effects.

The long term effects of Spivack and Shures' social problem-solving training were assessed and compared to an attention-placebo control. Thirty-seven preschool age children were involved in this year's long intervention project and six month follow-up. All subjects received 46 sessions of intervention by specially trained assistants. Support was found for the cognitive effectiveness of social problem-solving training with aberrant children at post test in that they gained significantly in their ability to generate alternative solutions to interpersonal problems. This differential effect was not sustained at follow-up. Blind teacher ratings of behavioral adjustment and independent observers' ratings of behavior (using a naturalistic observation scale developed for this study) revealed no significant behavioral training effects at post test or at follow-up. Findings are discussed with the suggestion that behavior change in young children may not be mediated through a strictly cognitive intervention, and may more logically require an integration of behavioral and cognitive techniques.

Behavior Therapy↗

Neurological and medico-social problems of spina bifida patients in adolescence and adulthood.

Chronological changes in the neurological manifestations of spina bifida are well recognized in the early developmental periods: fetal, neonatal, infantile, pre-school and school life. However, little has been written about the medical and medico-social problems of spina bifida patients in adulthood. Patients now in this age group had the condition diagnosed and managed in an era when modern neurosurgical concepts were only just beginning to be established with the aid of invasive methodology. In our series of 141 cases of spina bifida, 18 patients (13.5%) were over 16 years of age. These included 9 cases each of spina bifida aperta (myeloschisis) and spina bifida occulta (spinal lipoma). The ages ranged from 16 to 47 years (mean: 23.5 years) in the former and from 16 to 57 years (mean: 29.2 years) in the latter group. During the long-term follow-up with quantitative analysis of the spinal neurological changes using the spina bifida neurological scale (SBNS), the final outcomes appeared very grave. Except for 1 case in each group-1 grade III in the spina bifida aperta group and 1 grade II in the spina bifida occulta group-all patients over the age of 27 years were classed as having grade IV disease. There were 2 patients with spina bifida aperta in whom postoperative paraplegia appeared after delayed radical repair (at the ages of 3 years and 18 years) and 3 patients with spina bifida occulta in whom obvious neurological deterioration was observed as the natural history with ongoing paraparesis at the spinal level or late onset of sexual problems. The other group included 2 patients with spinal lipoma in whom late neurological deterioration was observed and who were obliged to undergo a second operation in spite of aggressive early procedures performed during infancy. Among the patients with spina bifida aperta, 2 had marked ventriculomegaly as a form of long-standing overt ventriculomegaly in the adult (LOVA). After the CSF shunt procedure both these patients had problems with delicate shunt dependence and requested fine shunt flow regulation. Two patients in this group also suffered from severe depression. This study involves a limited number of patients, but it may be useful for reference on various points: (1) future prospects for the management of pediatric cases of spina bifida as practiced in the majority of hospitals; (2) natural histories of untreated cases and surgical indications for preventive procedure in spinal lipoma in early infancy; and (3) internationally differing levels of management of spina bifida and the historical development of individual countries' approaches to the problems.

Adolescent↗

[Medico-social problems of young adolescents in Guediawaye (suburban area of Dakar-Senegal)].

A survey in the district of Guediawaye, towards teenagers from 12 to 16 years old, recruited according to a stratified risky method of sampling in 4 different areas has been carried out in order to evaluate their main medico-social problems. It ended up to the following findings: the majority live in hard socio-economic conditions stamping by promiscuity, a weak family income and a low level of education of the parents. 39.2% have been placed under the guardianship of a relative other than the parents. 98.8% do not find spare time structures in their environment. The usage of tobacco and drug is respectively 14% and 1%; 79.4% of students have hardly access to the school stationery, while the teenagers in job apprenticeship have constraints linked to long hours of work (95%). The morbid affections are too varied, dominated by stomach aches (37.8%) far before traumatics (6%); the most frequent therapeutic is resort traditional or empiric treatment. The authors advocate the setting up of a medico-social center making interfere all persons, implied resources in the undertake of the teenagers.

Adolescent↗

Association of social problem solving with glycemic control in a sample of urban African Americans with type 2 diabetes.

The Social Problem-Solving Inventory--Revised, Short Form, was administered to 65 urban African Americans with type 2 diabetes to examine association of generic problem-solving styles and orientation with hemoglobin A1C (A1C). Eighty-five percent of participants had total social problem-solving scores in the Average range or higher. In linear regression models adjusted for education, each interquartile increase in impulsive/careless score was associated with a 0.82 increase in A1C (%) (p = 0.01), and each interquartile increase in avoidant score was associated with a 1.62 increase in A1C (%) (p = 0.004). After adjusting for depressive symptoms, the association of impulsive/careless style with A1C was attenuated, while the association of avoidant problem solving with A1C remained significant (p = 0.01). Associations of rational problem-solving style, positive orientation, and negative orientation with A1C and health behaviors were not statistically significant. Ineffective problem-solving styles may prove to be important targets for intervention to improve glycemic control.

Adult↗

Race as biology is fiction, racism as a social problem is real: Anthropological and historical perspectives on the social construction of race.

Racialized science seeks to explain human population differences in health, intelligence, education, and wealth as the consequence of immutable, biologically based differences between "racial" groups. Recent advances in the sequencing of the human genome and in an understanding of biological correlates of behavior have fueled racialized science, despite evidence that racial groups are not genetically discrete, reliably measured, or scientifically meaningful. Yet even these counterarguments often fail to take into account the origin and history of the idea of race. This article reviews the origins of the concept of race, placing the contemporary discussion of racial differences in an anthropological and historical context.

Anthropology↗

Social problems and health in urbanization.

One of the main characteristics of urbanization in Asia is the very rapid increase in population movement from rural to urban centers. This phenomenon has led to changing population structure, its composition and lifestyles in the cities and its fringes. As a consequent of population pressure on urban system and infrastructure, compounded by the nature of the composition of the in-migrant population, the urban concentrates are faced with several social and socio-economic problems. Although there has been a lot of interests among researchers to study the causes and effects or urbanization, there is a vacuum in the area of health implications. Planners and administrators usually give priority to the physical aspects of the urban and urbanities. Social problems and health implications thereof receives very little attention either at the level of administration or research. This paper therefore is a brave attempt to focus and draw some attention to this neglected area by looking at selected social problems and the health consequences.

Crowding↗

Social problem solving in adolescents with suicidal behavior: a systematic review.

There is an increasing focus on deficiencies in problem solving as a vulnerability factor for suicidal behavior in general and hence a target for treatment in suicide attempters. In view of the uncertainty of evidence for this in adolescents we conducted a systematic review of the international research literature examining the possible relationship between deficiencies in social problem-solving skills and suicidal behavior in this population. This was based on searching two electronic databases: Medline 1966 to September 2003 and PsychInfo 1887 to September 2003. Twenty-two studies of social problem-solving skills in adolescents with suicidal behavior were found. Most of these studies, which compared adolescent patients with suicide attempts versus either nonsuicidal psychiatric or normal controls, found evidence for problem-solving deficits in the attempters; however, few of the differences remain after controlling for depression and/or hopelessness. Because most of the studies are cross-sectional, it is difficult to differentiate between the possibilities that deficiencies in problem-solving skills lead to depression when adolescents are faced by adversity and hence to suicidal behavior, or whether depression is the main factor which undermines problem-solving skills. Future research, preferably with longitudinal research designs, is required to determine the nature of the association between problem-solving skills and suicidal behavior in adolescents. This has important implications for therapeutic interventions.

Adolescent↗

Blindness as a challenging medical and social problem in China.

China, a country with about one fifth of the world's population, has been gaining a rapid economic growth since 1980s. This country has around 5 million blind people, accounting for 18% of the blind in the world. The major causes of blindness include cataract, corneal diseases, trachoma, glaucoma, vitreoretinopathy and a number of factors contributing to blindness in children. The principal cause of blindness in China was no longer trachoma but cataracts. Vitamin A deficiency remains a public health problem in the under-developed areas. Age-related conditions in China, such as vision loss due to cataract and retinal disorders, will increase accordingly if no preventive meaunes are taken. Glaucoma and diabetic retinopathy appear to be predominant induction of the devastating blind. In this fast developing country blindness is not only a medical or health, but also a social problem. Developed strategies have been adopted simultaneously by national efforts under the leadership of the government, international agencies, nongovernmental organizations, as well as private sectors in their every-day work to prevent and treat blindness.

Blindness↗