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PubMed2004

Enacting relationships in marriage and family therapy: a conceptual and operational definition of an enactment.

Enactments are a potential common clinical process factor contributing to positive outcomes in many relational therapies. Enactments provide therapists a medium for mediating relationships through simultaneous experiential intervention and change at multiple levels of relationships--including specific relationship disagreements and problems, interaction process surrounding these issues, and underlying emotions and attachment issues confounded with those problems. We propose a model of enactments in marriage and family therapy, consisting of three components--initiation operations, intervention operations, and evaluation operations. We offer a conceptual framework to help clinicians know when and to what purpose to use this model of enactments. We provide an operational description of each component of an enactment, exemplifying them using a hypothetical clinical vignette. Directions for future research are suggested.

Communication Barriers↗
PubMed1992

Elephantiasis: a disease of development in north east Ghana.

A reconnaissance survey for the presence of lymphatic filariasis is made in 41 chiefdoms of north east Ghana. Four disease levels are identified culminating in hyperendemic disease foci associated with two Government-introduced rice irrigation projects. Attention is also drawn to the disease effects of small village dams. Multiple concurrent infections are noted. Within the most stricken irrigation villages, aspects of concealment, stigma and marriage are considered. Failure to control lymphatic filariasis has led to hospital avoidance and neglect of the disease jointly by patients, physicians and nurses. Culpability rests with the irrigation authority and Government health services. An outline is given of possible measures for disease control. A multisectoral policy of 'prevention before development' is strongly advocated.

Agriculture↗
PubMed2005

Risk of HIV transmission within marriage in rural China: implications for HIV prevention at the family level.

BACKGROUND: Little is known about HIV transmission at the family level in China. GOAL: : We examined the risks for HIV transmission between husbands and wives and from parents to children in a rural area where HIV spread among former commercial blood donors. STUDY: A cross-sectional study was conducted among 605 (302 couples) marriage license applicants. RESULTS: More males (64.6%) than females (52.1%) reported having had premarital sex and multiple sex partners (12.6% and 6.9%, respectively). Among those having had multiple sex partners, 8.5% reported often or always using condoms. Only 36.8% of the couples agreed that they would not plan to have a baby after knowing the status of HIV infection. Approximately 43% of the couples agreed that they would use condoms consistently if 1 of them were HIV-positive. CONCLUSIONS: There is an urgent need for national programs to prevent HIV infection within couples in rural areas.

Adolescent↗
PubMed1976

A method for co-therapy for schizophrenic families.

This paper describes a model of treatment for families in which one child has been given the diagnosis of schizophrenia. Male and female therapists adopt structured roles that are used as a paradigm for exploring family patterns. The paradigm employs a three-generational hypothesis that defines schizophrenia as a lifelong, restricting mode of relating, involving the primary family triad, that makes the child vulnerable to repeated psychotic episodes. Therapy is directed at the difficulties of autonomous development within the family by focusing on differentiating the relationship between nuclear and extended family members, expecially defining and strengthening generational and sexual boundaries. The second focus of therapy is on the resolution of issues of separation and loss, with attention to unresolved mourning in the family of origin and the concomitant stress in giving up the infantile relationship with the index child in the nuclear family. Stages of therapy will be described including: (a) initiation of therapy, (b) breaking of fusion, (c) repair of alienation, and (d) solidifying the marital alliance and generational boundaries. Case illustrations will be included.

Anxiety, Separation↗
PubMed1975

Difficulties in brief conjoint treatment of sexual dysfunction.

The authors offered conjoint treatment of sexual dysfunction to an unselected population in a military hospital for one year. Of the 10 couples who requested treatment, 7 were treated by techniques outlined by Masters and Johnson. The couples who completed the treatment exercises improved, and neurotic interactions, presumably resulting from the symptoms, often disappeared. The couples who avoided the exercises had interactional patterns dominated by projection and blame, sadomasochism, and depressive features; typically their marital difficulties were aggravated by the treatment.

Adult↗
PubMed1994

The Effects of Marriage and Being a Parent on Prenatal Physician Visits for Chamorro, Filipino, White and Other Asian and Pacific Island Women on Guam.

PURPOSE OF THE PAPER: The purpose of this study was to examine the effect of marital status, parental status, and ethnicity on the frequency of prenatal physician visitations reported by Chamorro, Filipino, White, and other Asian and Pacific Island women residing in Guam. SUMMARY OF METHODS UTILIZED: Data were extracted from birth records and analyzed using ordinary least squares multiple regression. PRINCIPAL FINDINGS: We found that ethnic effects remained even when age, education, and region of residence on Guam were held constant. Marriage had a significant and positive effect on prenatal visitations, and a number of previoius children had significant negative effect on prenatal visitations. CONCLUSIONS: We conclude that spouses encourage positive health behaviors while the expectations of parenting detract significantly from the amount of time women can devote to caring for themselves. RELEVANCE TO ASIAN AND PACIFIC ISLANDER AMERICAN POPULATIONS: Our results indicate that marital status may be more important than educational levels for understanding the health care behaviors of Chamorro, Filipina, and other Asian and Pacific Island women on Guam. KEY WORDS: Chamorro, Filipino, prenatal visitations, marital status, parental status.

Journal Article↗
PubMed2005

Long-term consequences of childhood sexual abuse by gender of victim.

BACKGROUND: Childhood sexual abuse (CSA) is a worldwide problem. Although most studies on the long-term consequences of CSA have focused on women, sexual abuse of both boys and girls is common. Thus, a comparison of the long-term effects of CSA by gender of the victim will provide perspective on the need for future research, prevention activities, and treatment of survivors. METHODS: A retrospective cohort study was conducted from 1995 to 1997 among 17,337 adult HMO members in San Diego, California. Participants completed a survey about abuse or household dysfunction during childhood, and multiple other health-related issues. Multivariate logistic regression was used to examine the relationships between severity of CSA (intercourse vs no intercourse) and long-term health and social problems (substance use and abuse, mental illness, and current problems with marriage and family) by gender of victim. Models controlled for exposure to other forms of adverse childhood experiences that co-occur with CSA. Among men, the relationship between the gender of the CSA perpetrator to the outcomes was also examined. RESULTS: Contact CSA was reported by 16% of males and 25% of females. Men reported female perpetration of CSA nearly 40% of the time, and women reported female perpetration of CSA 6% of the time. CSA significantly increased the risk of the outcomes. The magnitude of the increase was similar for men and women. For example, compared to reporting no sexual abuse, a history of suicide attempt was more than twice as likely among both men and women who experienced CSA (p<0.05). Compared with those who did not report CSA, men and women exposed to CSA were at a 40% increased risk of marrying an alcoholic, and a 40% to 50% increased risk of reporting current problems with their marriage (p<0.05). CONCLUSIONS: In this cohort of adult HMO members, experiencing CSA was common among both men and women. The long-term impact of CSA on multiple health and social problems was similar for both men and women. These findings strongly indicate that boys and girls are vulnerable to this form of childhood maltreatment; the similarity in the likelihood for multiple behavioral, mental, and social outcomes among men and women suggests the need to identify and treat all adults affected by CSA.

Adult↗
PubMed2006

The context of aggressive behavior in marriage: a longitudinal study of newlyweds.

Under what circumstances are spouses more or less likely to engage in aggressive behaviors? To address this question, the current study drew on multiple longitudinal assessments of 1st-married newlyweds to examine correlates of within-subject variability in aggressive behavior. Controlling for marital satisfaction, the authors found that spouses were more likely to engage in physical aggression at times when they engaged in higher levels of psychological aggression. Additionally, husbands reporting higher levels of chronic stress were more likely to engage in physical aggression overall and were more likely to engage in physical aggression when they were experiencing higher than average levels of acute stress. These results highlight how demands and supports in the context external to a marriage may affect processes within the marriage.

Adult↗
PubMed1993

Enhancing the usefulness of quadrant analysis in hospitals: a marriage with discriminant analysis.

This paper first looks at traditional quadrant analysis as used in contemporary research. Next, we show an extension to include multiple brands on the same quadrant chart--again consistent with current practice. Then, multiple discriminant analysis results are merged with the quadrant chart data. This makes the resultant chart even more actionable. While the example uses health care data, the methods outlined can be used in other segments of the service industry, as well as for more tangible products. The only limit is the researcher's imagination.

Consumer Behavior↗
PubMed1990

Two cases of congenital hepatic fibrosis in children of consanguineous marriage.

An association of congenital hepatic fibrosis (CHF), Caroli's disease, medullary sponge kidney, type II interventricular defect with right transposition of the aorta, multiple cervical vertebra malformations, and first sacral vertebra schisis in a 16 year old son of consanguineous parents (consanguinity factor = 1/32), is described. The patient's sister presented asymptomatic CHF and medullary sponge kidney only. Parental consanguinity in this case lends support to the view that CHF, medullary sponge kidney and cardiac malformations are more likely to be manifestation of a single recessive gene, with a varying phenotypic expression, than of different mutant genes.

Adolescent↗
PubMedDate not supplied

Surveillance of psychosomatic disorders in internal medicine in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

AIM: to examine certain characteristics of patients who suffer from psychosomatic disorders. METHODS: We called data through medical report outpatient clinic of the Psychosomatic Division, Department of internal medicine, Cipto Mangunkusumo Central General Hospital/Faculty of Medicine of the University of Indonesia (FKUI/RSUPN-CM), Jakarta, Indonesia, in 1996. The data was processed manually and by computer from which table and graphic were obtained. The descriptive analysis was performed to the objective the study. RESULTS: the FPD patients consisted of those with vegetative imbalance (multiple psychosomatic syndrome) (30.2%), dyspepsia (20.8%), functional heart disease (11.3%) and others 1%-6%. All of SPD consisted of chronic disease, such as hypertension (38.3%), diabetes mellitus (29.8%), bronchial asthma (10.6%), coronary artery disease (6.4%), and others 2%-5%. According to DSM IV, among the psychosomatic patients, 52.7% met the criteria for anxiety, 29.3% for depression, 14.2% for mixed anxiety and depression, and 3.8% unclear. The psychosocial stressor groups were family problems (38%), physical conditions (16%), work-related problems (13.4%), marriage problems (8.4%) and others (1%-4%). CONCLUSION: The most common physical symptoms of psychosomatic disorders were functional. Common functional psychosomatic disorders were multiple psychosomatic syndrome, dyspepsia and functional heart disease. Structural disorders found were chronic diseases. There was no difference in prevalence between males and females. The most frequent functional disorders were more commonly found among those under 40 years of age, while those with structural disorders were more common among patients 40 years of age or more. The psychological diagnoses were anxiety and depression. The most frequent psychological stressors were family problems, medical conditions, work-related problems and marriage problems.

Adult↗
PubMed1989

Effects of multiple roles on women's health--evidence from a national longitudinal study.

This study analyzes longitudinal data for a national sample of older middle-aged women in order to assess the health effects of three roles--labor force participant, spouse and parent. Women who held more roles had better health trends. The effect of each specific role varied, depending on race and the other roles a woman held. For example, our evidence indicates that labor force participation had beneficial effects on health for white women who were not married and for black women who had children at home, but not for other women. The findings of this study do not support the hypothesis that involvement in multiple roles contributes to role overload and role conflict with consequent harmful effects on women's health. Rather, it appears that involvement in multiple roles generally contributed to better health, due to the beneficial effects of labor force participation and marriage for some women.

Adult↗
PubMed1993

Sado-masochism in Charlotte Brontë's Jane Eyre: a ridge of lighted health.

Charlotte Brontë's Jane Eyre contains a paradox of character: Jane Eyre is an assertive successful woman, who marries, after every obstacle is overcome, the man she loves; she is also a traumatised, terrorised child, who later becomes deeply involved, to the point of losing herself, with a moral sadist. In the critical literature on Jane Eyre there is controversy concerning Brontë's aims in the characterisation of her fictional autobiographer. Did Brontë's artistic control of character slip and result in Jane Eyre's irreconciliable attributes? Did she mean to give us an assertive feminine heroine and instead reveal her own castration complex in the marriage to a maimed and near-blind man? The hypothesis of this paper is that the multiple functions of masochism--adaptive, defensive and gratifying--the multiple defence mechanisms at work in masochism--denial, introjection and projection--and the special layering of masochism at each developmental level--oral, anal, and phallic--are mirrored in Brontë's characterisation. The irreducible complexity of the clinical concept of masochism finds its match in Brontë's characterisation of Jane Eyre.

Adaptation, Psychological↗
PubMed1998

Paediatric hearing loss in rural Pakistan.

OBJECTIVE: The present study was designed to generate population-based data on the prevalence and causes of hearing loss in rural Pakistani children. A community screening programme was utilized to identify and evaluate the hearing impaired. METHODS: The study was performed in conjunction with the Ministry of Population Welfare in Sialkot District, Punjab Province. School-aged children between the ages of 5 and 15 years were screened and examined for hearing impairment according to World Health Organization (WHO) protocols. Case-control analysis of audiometric, physical examination, and risk factors for hearing loss were performed, followed by chi-square analyses. RESULTS: A total of 607 children comprised the study population, with an overall point prevalence of hearing impairment of 7.9%. Fifty percent of all hearing loss was conductive in nature, amenable to either medical or surgical therapy. The risk factors most associated with conductive hearing loss were otorrhea and multiple ear infections greater than 5. In cases of severe hearing loss, 70% were the result of consanguinous marriages. Almost no cases of hearing loss were attributable to measles, mumps, rubella, and the TORCH infections. CONCLUSION: This study has generated some badly needed population-based data on the magnitude of the problem of hearing loss in rural Pakistan. It is hoped that the results of this work will stress the importance of hearing health in Pakistan and to encourage other professionals to pursue similar projects.

Adolescent↗