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A historical perspective on the University of Nebraska Medical Center's College of Dentistry Class of 1961.

We conducted a retrospective analysis of the University of Nebraska Medical Center (UNMC) College of Dentistry (COD) Class of 1961 to glean information that might be useful in the design of dental education programs in Nebraska and elsewhere. We scanned annual class newsletters, demographic statistics for students entering the UNMC dental program for each decade from 1961 to 2001, and UNMC COD alumni data for patterns and themes among thirty-two dental professionals. Eighty-four percent of those contacted provided responses to a survey. We found that, like current dental cohorts nationwide, the UNMC COD Class of 1961 is mostly of European ancestry (non-Hispanic) and male. But in contrast to current dental college graduates, the UNMC Class of '61 were able to rely upon self-employment and spousal and/or military support (GI Bill) to cover the costs of their dental education. They also were more likely to enter dental school before completion of an undergraduate degree and have a substantial work history before entering the UNMC dental program. Although the most common reason for attending dental school related to independence and financial security, "time with family" and "family vacations" were the next most important reasons cited for becoming dental professionals. Among '61 graduates, the average number of years spent in the dental profession is thirty-seven years. Despite the notable changes in dental technology and the continual need for updating knowledge and skill, eight members of the UNMC COD Class of 1961 continue to practice dentistry. Most maintain contact with other class members, providing support to former classmates and maintaining an identity with their alma mater, the University of Nebraska.

Cohort Studies↗

Widowhood and depressive symptoms among older Chinese: do gender and source of support make a difference?

In this study, we examined the effects of gender and pre-bereavement social support from three different sources (spouse, adult children, and friends) on widowhood adjustment among older adults in China. Hypotheses were developed by integrating the literature in the West and the cultural context of China. Data came from a panel survey, conducted in 1991 (baseline) and 1994 (follow-up), of a probability sample of older persons in Wuhan, China. For the present analysis, only those who were married with children at baseline were selected (N = 1,263). About 10% of the sample experienced spousal death between the two measurement points. Multiple regression analyses suggest that widowhood had a negative mental health consequence for older Chinese. Social support from adult children buffered the deleterious effect of widowhood, whereas spousal support during the marriage increased one's vulnerability. Support from friends was not found to have a significant effect. Gender difference in the effect of widowhood was also not evident. In this study, we have extended bereavement and social support research to a developing nation, with some findings similar to and some different from studies in Western developed nations.

Adaptation, Psychological↗

Employed Mexican women as mothers and partners: valued, empowered and overloaded.

This study was designed to explore the daily lived experiences of a group of employed, low-income Mexican women in their maternal and spousal roles. The participants were 41 auxiliary nurses recruited from two large urban hospitals in Mexico. Data were collected through the Women's Roles Interview Protocol (WRIP), which solicited the participants' perceptions of the satisfaction and stresses they experienced in their roles as mothers and spouses, and their descriptions of the coping strategies and the resources they used to deal with stressful life experiences related to these roles. Data analysis consisted of a qualitative thematic analysis of the narrative responses to open-ended questions in the WRIP. Satisfying aspects of the maternal and spousal roles, as identified by the participants, included giving to and receiving from their children and being valued and supported by their partners. Spousal approval of their work was also satisfying. These employed mothers, however, experienced many stressful aspects of functioning in multiple roles, including lack of resources, being absent from their children, self-doubt about their maternal role functioning, role overload and spousal absences. The women coped by juggling priorities and utilizing family resources. From the data analysis, the investigators developed a conceptual framework for understanding these women's experiences with parenting and marriage. The centrality of the family, a sense of value and empowerment as women in maternal and spousal roles, and the reality of role overload are discussed within the Mexican culture context of machismo, its female counterpart hembrismo, and family life. Implications for women's health are framed within a context of family and work.

Adaptation, Psychological↗

Spousal influence on smoking behaviors in a US community sample of newly married couples.

Among married couples, partners often have similar characteristics and behaviors. Among individuals who smoke cigarettes, it is not uncommon for them to have a partner who also smokes. In fact, having a partner who smokes can influence the spouse's initiation of smoking, or return to smoking after a previous quit attempt. Additionally, it is possible that a nonsmoking partner can influence his/her spouse to stop smoking. Participants for this research are from a community sample of couples in the United States. They were recruited at the time they applied for their marriage license and followed through to their second wedding anniversary. Logistic regression models, controlling for demographics, were utilized to determine if a partner's smoking status predicted smoking initiation or relapse over the early years of marriage. Overall, there was some support that a partner's smoking status did influence the other's smoking, although more support was found for spousal influence on relapse than cessation. There was more support for husband's influence compared to wife's influence, nonsmoking wives were more likely to resume smoking in the early years of their marriage if their partners were smokers. Wives' smoking, however, did not predict husband initiation of smoking. These findings suggest that during the transition into marriage, spouses do influence their partners' behaviors. In particular, women are more likely to resume smoking, or return to smoking if their partners smoke.

Adult↗

The development of an empirical psychosocial taxonomy for patients with diabetes.

The main purpose of this study was to develop and to cross-validate an empirically derived psychosocial taxonomy of patients with diabetes. In the first study, 101 patients with Type I or Type II diabetes completed the Multidimensional Diabetes Questionnaire. Cluster analysis identified three clusters, labeled adaptive copers, low support-low involvement, and spousal overinvolvement. In the second study, the taxonomy was cross-validated using an independent sample of 132 patients with long-standing Type II diabetes. The results confirmed that the multivariate classification system was unique and highly accurate. External validation, using general psychological as well as diabetes-specific measures, supported the validity and distinctiveness of the patients' profiles. These findings help establish a multiaxial psychosocial taxonomy of diabetes and may have significant implications for the management of patients with diabetes.

Adaptation, Psychological↗

The spouse as a kidney donor: ethically sound?

A shortage of cadaver donor organs requires transplant units to examine all possible alternatives. Transplantation from living donors accounts for only approximately 10% of kidney transplants in the UK. Recent studies have shown that the results of kidney transplantation between spouses are at least as good as those of well-matched cadaver organs, but very few transplants of this type have been performed in this country so far. As part of the assessment process, the proposed donor and recipient are required to provide written statements about the issues. We reproduce here the personal statements made by one of our patients and his wife: we believe that the statements support our contention that spousal transplantation is ethically justifiable and should be more widely available. We report our early experience in Bristol with seven kidney transplants from spousal donors and we encourage other renal units in this country and elsewhere to consider this method of improving the prospects of kidney transplantation for their patients.

Adult↗

Therapeutic touch. A holistic approach to perioperative nursing (continuing education credit).

1. A technique of noncontact touch called Therapeutic Touch (TT) is beneficial for relieving anxiety in hospitalized patients; enhancing spousal sharing and emotional support during childbirth; increasing hemoglobin levels; lowering postoperative pain; decreasing tension headache pain; decreasing premature neonate's stress response; and increasing the rate of healing for full thickness dermal wounds. 2. There are four observable physical changes that occur in a TT recipient: His or her voice drops several decibels, respirations become slower and deeper, audible signs of relaxation (ie, sigh) are expressed, and a peripheral flush is readily perceived on his or her face. 3. The individual may experience an immediate response, although it may take hours or even days for any change to occur. An essential premise of TT, however, is that the practitioner be compassionate. This compassion must be a caring intent--not personal--and without attachment to the outcome. The TT treatment is rarely tiring for the practitioner and can be rewarding if practiced correctly.

Anxiety↗

Risk factors for severe child discipline practices in rural India.

OBJECTIVES: To determine the type and severity of discipline practices in rural India and to identify risk and protective factors related to these practices. METHODS: Five hundred mothers, ages 18-50, participated in face-to-face interviews as part of a cross-sectional, population-based survey. One of the mother's children was randomly selected as the referent child. The interview focused primarily on discipline practices and spousal violence. Sociodemographic characteristics, neighbor support, residential stability, and husband's drinking behavior were also assessed. RESULTS: Nearly half of the mothers reported using severe verbal discipline and 42% reported using severe physical discipline. While common, severe discipline practices occurred less frequently than moderate practices and had different risk factors, notably low maternal education and spousal violence. CONCLUSIONS: Results suggest that increased formal education for rural women in India may have the added benefit of reducing family violence, including spouse and child abuse.

Adolescent↗

Parenting stress and social support of mothers who physically abuse their children in Hong Kong.

Thirty-seven identified abusive mothers were matched on demographic and socioeconomic parameters with a known nonabusive comparison sample in order to examine the role of parenting stress and maternal social support. The mothers were assessed using a personal (demographic) questionnaire, the Parenting Stress Index (PSI), and the Maternal Support Index (MSSI). Demographic data showed that the two groups were comparable on all variables except abusive mothers had significantly more children (p = .01). Abusive mothers showed significantly more stress on total PSI scores (p = .005), as well as in all three of the subjects: Child Domain (p = .007) Parent Domain (p = .02), and Life Stress (p = .016). Abusive mothers scored lower in all seven items on the MSSI. The difference was significant on the MSSI as a whole (p = .007) and on four subsets: number of people to count on in time of need (p = .02), perceived neighborhood support (p = .04), satisfaction with spousal relationship (p = .01), and degree of community involvement (p = .03). The greatest percentage (74.32%) of correct predictions of child abuse was achieved by combining the number of children, the Life Stress Scale and the MSSI. Implications for future research are discussed.

Adult↗

Correlates of wellbeing of spousal and children carers of disabled people over 65 in Spain.

BACKGROUND: The aim of this study was to evaluate the associations between carer's wellbeing and stressors and to assess if these associations are different for spousal and children carers of disabled elderly. METHODS: Information was collected by home interviews of a population sample of carers (N = 195), who were providing assistance in activities of daily living to a community-dwelling population over 65. Associations between indicators of wellbeing (number of depressive symptoms, number of physical symptoms, self-perceived health and life satisfaction) and caring stressors were examined, controlling for carer's socio-economic characteristics and health status. Hierarchical logistic regressions were used to fit the data. Religion and social support were included as resources and spousal and children differential associations were tested. RESULTS: The four indicators of wellbeing are moderately correlated, indicating a common underlying concept. Spousal carers have lower socio-economic status, poorer health and lower levels of wellbeing than children carers. However, children carers bear a significantly greater burden. In the multivariate analysis of the associations between wellbeing and stressors, the similarities between spouse and adult child carers are more striking than the differences. Emotional support was consistently associated with higher levels of wellbeing while the associations of religiosity and instrumental support with wellbeing did not reach statistical significance. CONCLUSION: As formal care services are being developed in Spain, their ability to work in a supportive way with family networks should be taken into account. Research should be carried out on patterns of formal care interventions that use the resources in the natural support network of the family.

Aged↗

Wealth flow and fertility decline in rural Kenya, 1981-92: a reassessment of the evidence.

In 1981 and 1992, identical questionnaires measuring lineal and lateral wealth flows and emotional nucleation were administered to comparable samples of male household heads in rural Kenya. The 1981 results, showing limited evidence of economic or emotional nucleation within the household, were consistent with prevailing high fertility. By 1992 desired and observed fertility had declined significantly, but nucleation levels remained the same. The question then arose as to whether our bivariate measurements had been too coarse to detect subtle shifts in nucleation and/or the simultaneous effect of other independent variables. To resolve these issues, we re-examined our 1981 and 1992 data sets using regression analysis. The findings suggest that the independent contribution of wealth flow and emotional nucleation variables to explained variance in the desired number of children by rural male heads of households was limited, being approximately seven to 10 percent in 1981 and 10 to 18 percent in 1992. However, we observed that the independent variables picking up the explanatory slack in the current exercise were largely ideational in nature, having to do with the expectation of future child support, education, form of marriage, and spousal perception, communication, and consensus on key family size and family planning variables.

Adult↗

Spousal characteristics as predictors of well-being in older couples.

This study examined the relations between spousal variables and the psychological well-being of husbands and wives in older couples to determine if spousal characteristics were more important determinants of well-being for wives than for husbands. One hundred-twenty older married men and women completed standardized self-report measures and a short interview. The variables investigated included education, verbal intelligence, personality, physical health, marital adjustment, psychological well-being, as well as response bias to marital defensiveness. Spousal variables significantly predicted wives' well-being (R2 = 29%) with the three most influential predictor variables being the husbands' perception of the marriage, positive dimension of well-being and physical health. In contrast, spousal variables did not significantly predict husbands' well-being. The study supported the hypothesis of differential responsiveness of men and women to spousal variables and highlighted the importance of marital adjustment for the psychological well-being of older wives.

Aged↗

Experiences of well spouses after lung transplantation.

AIM OF THE STUDY: To explore what life is like for well spouses after their partners' lung transplantation? BACKGROUND: The numbers of people having a lung transplant in the United States of America (USA), as well as surviving beyond 1 and 5 years, has increased steadily over the last decade. This trend is expected to continue. Few have examined the transplant experience from the view of well spouses who are the most typical patient-support person. Researchers have shown that spousal adjustment is closely associated with patient adjustment and recovery. DESIGN/METHODS: Using written surveys and taped telephone interviews in 1998, a convenience sample of 12 well spouses shared details of their lives after their partners' lung transplant. Spouses from eight states in the USA responded to an invitation to participate which was posted on an internet listserv. Ages ranged from 40 to 66 years and the posttransplant time ranged from 4 to 60 months. Spouses completed a demographic form, the Family Inventory of Life Events (FILE), and the Center for Epidemiologic Studies Depression Scale (CES-D) prior to interview. Triangulation of methods augmented and corroborated data. Interviews stopped when saturation was reached. Data collection and analyses were carried out simultaneously using a constant comparative method. RESULTS: The core theme was the "roller coaster ride" characterized by a series of ups and downs. Other major themes were coping, giving medications, knowing the donor, making comparisons, togetherness, and caring for the well spouse. Five identified stages were: the transplant event, cocooning, normalizing, branching-out and settling down. CONCLUSIONS: This study supports nurses using a family centred focus. Nurses in all practice areas can apply information gained from this study to help spouses anticipate chaos at each stage and develop effective coping strategies.

Adaptation, Psychological↗

An ecological-transactional model of significant risk factors for child psychopathology in outer mongolia.

The present study examined significant risk factors, including child maltreatment, for child psychopathology in a cross-cultural setting. Ninety-nine Mongolian boys, ages 3-10 years, were assessed. Primary caregivers (PCG) completed structured interviews including the Emory Combined Rating Scale (ECRS) and the Mood and Feelings Questionnaire (MFQ). Structural equation modeling identifies eight risk factors affecting child psychopathology: Three with direct effects (severity of physical punishment, PCG's MFQ score, and PCG's education), three with indirect effects (cultural acceptance of violence as discipline, presence of community violence, and contact with extended family), and two with direct and indirect effects (quality of marriage/presence of spousal abuse, and household size). Results support the ecological-transactional theory of developmental psychopathology in a cross-cultural setting. Structural equation modeling provides a useful technique to isolate specific sites for intervention, while maintaining a comprehensive perspective of risk factor interaction.

Anxiety↗

Fatigue among elders in caregiving and noncaregiving roles.

Fatigue is a complex symptom prevalent in informal caregiving. When role demands exceed caregiver resources, fatigue ensues and caregiving can be compromised. The purpose of this study was to compare perceptions of fatigue among older adults (N = 92) caring for spouses with Alzheimer's disease, Parkinson's disease, or cancer with a control group of older adults (N = 33) whose spouses required no extra care. Caregiving elders reported more fatigue, less energy, and more sleep difficulty than did control participants. All caregiving groups reported similar levels of fatigue, energy, sleep, and self-reported health even though there were marked differences regarding spousal status. Health care providers can support older caregivers in monitoring their own health and in recognizing the need for services that support the caregiving role.

Aged↗

Family coping and bereavement outcome.

Using a three-phase longitudinal design, the bereavement of 115 adult Australian families following the death of a parent from cancer was studied. The cohort comprised 115 spouses and 153 offspring: 670 individual responses were obtained. A range of psychosocial variables was studied through a semistructured interview covering the experience of the deceased's illness, death and funeral, spousal health, family coping, sources of support, use of ritual and completion of estate duties. Bereavement outcome was measured by standardized questionnaires of the intensity of grief (Bereavement Phenomenology Questionnaire), depression (Beck Depression Inventory), psychological distress (Brief Symptom Inventory) and social adjustment (Social Adjustment Scale). Those psychosocial variables found to be significantly correlated with bereavement outcome were entered into best sub-set regression analyses. Family coping was the most consistent correlate of bereavement outcome in these regression analyses, which accounted for up to 38% of the variance in grief, 64% in distress, 53% in depression and 46% in social adjustment. The nature of family functioning is a key aspect of social support in influencing the outcome of bereavement.

Adaptation, Psychological↗

Family involvement and outcome in treatment of alcoholism.

The purpose of the study was to determine the effect of spouses' (or significant others') involvement in the treatment of alcoholism. Altogether 80 adult patients who had been treated for alcoholism participated. There were three groups who varied in involvement: Group I whose spouses attended 3 or fewer group therapy sessions per week, Group II whose spouses attended 4 or more sessions per week, and Group III whose spouses were treated as inpatients for coalcoholism. Information was gathered through personal interviews as part of the treatment follow-up plan no less than six months after release. The results suggest strong associations between greater family involvement and abstinence (at least six months), better family relations, and positive feelings about self. Further work should consider factors contributing to greater spousal involvement and the nature of support received after treatment.

Adult↗

Synergism of frail rural elderly couples: influencing interdependent independence.

In this phenomenological study, a purposive sample of 19 frail rural elderly couples were interviewed as dyads to identify programs, services, and relationships perceived by the couples as beneficial to their ability to continue to live independently in the community. Communication between the partners, and roles and relationships were observed and discussed. Findings showed that mutually supportive dyads generated a synergism or energy that acted as a vital resource to couples. Research results led to the development of a continuum of spousal relationships and a trajectory of couple communication. Support to the couple as a unit, to the couple relationship, and to address the couple's needs may be strategic foci for nurses in their delivery of care and their involvement in planning programs and developing policy.

Activities of Daily Living↗