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PubMed1987

National Development Plan, 1985-1991.

The following are provisions of this Plan [Botswana National Development Plan] relating to maternal-child health care and family planning: "14.73 Maternal Child Health and Family Planning (MCH/FP) tasks during NDP6 will include: the improvement of maternal and child health and family planning promotion, follow up and participation at the home level through strengthening of the family welfare educators in this area and data collection and use; increased knowledge and support of maternal and child family planning in the general population, with special emphasis on the male population and youth; the development of an integrated approach to MCH/FP care which is effective, efficient, and acceptable at the community level; the identification of high-risk groups among pregnant women, mothers, and children and appropriate intervention; the protection of the health of mothers and infants through planning services, so that each family will be of a reasonable size, corresponding to its socioeconomic and health conditions. 14.74 Specific Maternal and Child Health and Family Planning targets are: infant mortality rate - below 50/1000 live births; women of reproductive age using FP - 25%; pregnant women attending antenatal clinics - 98%; supervised deliveries - 70%; newborn babies with birth weight of at least 2500 g - 90%; children under one year of age fully immunized - 75%. 14.75 In order to reduce infant illness and deaths caused by preventable diseases, the Expanded Programme of Immunization has increased its target to vaccination of all eligible children by the year 1990. For this to be achieved, accessibility of the services to the communities should be improved and this can only be done within the context of the overall development of the basic health services."

Africa↗
PubMed1995

Contemporary transatlantic developments concerning compelled medical treatment of pregnant women.

This paper had identified a contemporary ethicolegal dilemma concerning the circumstances, if any, in which a pregnant woman's refusal of medical treatment may be judicially overridden either in her interests or those of the unborn child. On the one hand, the obstetrician will be concerned about the interests of both his patients in potentially life-threatening situations when they can be protected by what might be regarded as relatively straightforward procedures and where to fail to take those steps might expose the practitioner (at least outside New Zealand where its accident compensation legislation has impact in this regard) to allegations of negligence. On the other hand, the imposition of treatment in these circumstances will necessarily interfere with the woman's rights of autonomy and self-determination. In such cases also, the conduct of medical procedures in the face of an express prohibition by the woman may give rise to liability for battery. (In New Zealand, such a potential liability would not, in the writer's view, be affected by the prohibition on proceedings for damages for medical misadventure as contained in the Accident Rehabilitation and Compensation Insurance Act 1992.) At the heart of an analysis of this issue is the status of the fetus as it is the fact of the woman patient's pregnancy which distinguishes the cases discussed in this paper from others in which the Courts have had to deal with refusals of treatment by those competent to do so. In regard to this aspect, the approach of the Courts in various jurisdictions has arguably been confused and contradictory.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗
PubMed2002

Consensus conference on environmental values in radiation protection: a report on building consensus among experts.

During the fall of 2001 (October 22-25), The Norwegian Radiation Protection Authority (NRPA) and the Agricultural University of Norway arranged a consensus conference on the protection of the environment against ionising radiation. The motive for the conference was the need to study the ethical and philosophical basis for protection of nature in its own right. The conference was funded by Nordic Nuclear Safety Research (NKS), in cooperation with the International Union of Radioecology (IUR). The National Committee for Research Ethics in Science and Technology (NENT) was hired as facilitators for the consensus process. This paper will give a brief outline of the aims and method of the conference, distinguishing these from other kinds of consensus conferences. The paper ends with some general reflections on the appropriateness of seeking consensus on ethics-related issues among experts.

Bioethical Issues↗
PubMed1982

Prosthodontic rehabilitation for glossectomy patients.

Patients with oral carcinomas often have resection of the tongue, the floor of the mouth, or the bone of the mandible. Postoperatively, these patients encounter chewing, swallowing, and speech problems. Oral rehabilitation through prosthetic management can aid in alleviating these problems. Designs of the prosthesis vary according to patient needs. A "snap-on" tongue prosthesis or palatal augmentation prosthesis can be constructed. Total glossectomy patients require prosthetic intervention on a mandibular framework. Partial glossectomy patients require prosthetic augmentation on a maxillary framework. Through prosthetic management of this type, articulation and resonance are improved, food is more easily directed into the esophagus, tissues are protected and socialization is enhanced through improved appearance.

Deglutition↗
PubMed1988

Assessment of Space Station design and operation through Bioastronautics.

The paper reviews the main elements and major issues affecting human productivity and discusses some selected factors which might not be sufficiently identified and/or considered from the Bioastronautics point of view at the present stage of planning Space Station design and operation.

Aerospace Medicine↗
PubMed1995

The measurement of maltreatment: a comparison of approaches.

This study examined the comparability and predictive validity of three approaches to the measurement of child maltreatment. Adolescents (N = 160, aged 11-17) were randomly selected from the open caseload of a child protection agency. Global ratings of maltreatment severity were made by three reporting sources: researchers on the basis of protection agency case files, protection agency social workers, and the adolescents themselves. Ratings were made of five types of maltreatment: physical, sexual, emotional, neglect, and exposure to family violence. Self-reported (YSR) and caretaker-reported (CBCL) adjustment measures were also obtained for each subject. Results indicated that over 90% of the sample had experienced more than one type of maltreatment. Comparison of ratings across sources indicated considerable disagreement with respect to judgments of maltreatment occurrence and severity. Relative to professional ratings, adolescent ratings were better predictors of externalizing and internalizing symptomatology in both univariate and multivariate analyses.

Adolescent↗
PubMed2005

Forecasting environmental equity: air quality responses to road user charging in Leeds, UK.

Sustainable development requires that the goals of economic development, environmental protection and social justice are considered collectively when formulating development strategies. In the context of planning sustainable transport systems, trade-offs between the economy and the environment, and between the economy and social justice have received considerable attention. In contrast, much less attention has been paid to environmental equity, the trade-off between environmental and social justice goals, a significant omission given the growing attention to environmental justice by policy makers in the EU and elsewhere. In many countries, considerable effort has been made to develop clean transport systems by using, for example, technical, economic and planning instruments. However, little effort has been made to understand the distributive and environmental justice implications of these measures. This paper investigates the relationship between urban air quality (as NO2) and social deprivation for the city of Leeds, UK. Through application of a series of linked dynamic models of traffic simulation and assignment, vehicle emission, and pollutant dispersion, the environmental equity implications of a series of urban transport strategies, including road user cordon and distance-based charging, road network development, and emission control are assessed. Results indicate a significant degree of environmental inequity exists in Leeds. Analysis of the transport strategies indicates that this inequity will be reduced through natural fleet renewal, and, perhaps contrary to expectations, road user charging is also capable of promoting environmental equity. The environmental equity response is, however, sensitive to road pricing scheme design.

Air Pollution↗
PubMed2005

Effect of specific aspects of community social environment on the mortality of individuals diagnosed with serious illness.

The purpose of this study was to examine the prospective and contextual effects of urban community environment on mortality among Medicare beneficiaries who were 67 years old or older in 1993, lived in the city of Chicago, and were hospitalized for one of 13 serious diseases. As expected, we found that advantageous socioeconomic context helps lower mortality risk among elderly patients over and above individual demographic and health background. We also found that collective efficacy was a health-enhancing social resource whereas criminal and violent activities in the community appeared to be deleterious. Inconsistent with our hypotheses, community social network density (measured by the size of social network and frequency of social interaction) was not protective but detrimental. Moreover, social support and the civic involvement of residents in the community do not seem to affect mortality. The complex relationship between community social environment and health found in this study may suggest that community-level social interventions based on social capital/social cohesion models are not likely to achieve fruitful results without concomitant effort in the economic and health care realm, at least in terms of influences on the health of older people once they are already ill.

Acute Disease↗
PubMedDate not supplied

Development of an instrument to measure cardiac illness dependency.

OBJECTIVE: Dependency is frequently mentioned in the literature as a response of patients with cardiac disease. The purpose of this study was to develop and test a measure of dependency occurring in response to a cardiac illness. Illness dependency is defined as the need for emotional protection and social support after a significant change in health. DESIGN: Instrument development study. SAMPLE: Convenience sample of 311 patients with cardiac disease. RESULTS: The final version of the instrument has 25 items, each of which is measured on a 5-point Likert-type scale. Content validity was demonstrated using a panel of experts. Internal consistency of the total scale was 0.90; subscale alpha coefficients ranged from 0.64 to 0.81. Exploratory factor analysis supported a four factor solution: Attention, Reassurance, Concern, and Assistance, which accounted for 57.4% of the variance in scores. Discriminant validity was demonstrated by a low correlation with neuroticism. Social desirability of responses was minimal. CONCLUSION: Internal consistency reliability, content validity, and discriminant validity of the Illness Dependency Scale have initial support. This instrument is ready for use in research in which the investigator wishes to measure dependency associated with cardiac illness.

Aged↗
PubMed2000

Stressful life events and psychological distress of the very old: does social support have a moderating effect?

The purpose of this paper was to examine whether social support has a moderating effect on the relationship between exposure to stressful life events and psychological distress. To test this, 224 men and women aged 81-86 were sampled from two municipal regional counties: Sherbrooke (and vicinity) and Trois-Rivières, in the Province of Quebec, Canada. The French version of the Geriatric Scale of Recent Life Events, the Psychiatric Symptom Index, and the Social Provision Scale were used. Multiple regression analyses revealed that social support did not cancel out the deleterious effect of life events on the outcome measure. The negative aspect of social interaction may explain why social support did not have a protective effect. Also, social isolation resulting from psychological distress could reduce the opportunity for instrumental help and emotional support.

Journal Article↗
PubMed1996

Handover: an ethnographic study of ritual in nursing practice.

Three times every day in most of the hospitals and nursing homes in the UK, the so-called ritual of handover takes place. This ethnographic study examines that practice. The handovers of one ward were observed to see if they warrant the label of ritual as described by Helman (1990). Further analysis was performed to examine the functions and meanings of this practice. The conclusion from the analysis is that this practice does merit the label of ritual. Ritual is examined in terms of its meaning and found to serve valuable psychological, social and protective functions for its unwitting participants. Ritual serves another function, it plays an important role in valuing and emphasising what comes to constitute working nursing knowledge. In conclusion, ritual should not be dismissed by a profession which claims a holistic approach as its espoused theory, but further investigated and utilised as a means for accessing nursing knowledge.

Ceremonial Behavior↗
PubMed1999

Marital status transitions and psychological distress: longitudinal evidence from a national population sample.

BACKGROUND: Evidence is conflicting as to whether the association between marital status and psychological distress is due to selection (i.e. distress influences marital status) or causation (marital status influences distress). We investigate: (i) whether differences in psychological distress pre-date marital transitions; (ii) whether levels of distress change following transitions; and (iii) potential mediating and moderating factors. METHODS: Data on psychological distress (indicated by the Malaise Inventory) and marital status at ages 23 and 33 were analysed for 4514 men and 4842 women from the 1958 birth cohort. RESULTS: Higher levels of distress were found among the divorced and lower levels among the single and the married. Selection was seen in the lower initial mean symptoms of those who married (1.69 for men; 2.84 for women) compared to those remaining single (2.41 for men; 3.26 for women). Causation was indicated by the relative deterioration in distress of those who divorced compared to the continuously married (an increase of 0.31 and 0.03 respectively for men), especially in women (a decrease of 0.18 versus 0.71). This was most evident in women who were downwardly mobile and those with children. Recently separated men and women showed especially large increases in distress. CONCLUSIONS: The relationship between marital status and psychological distress involves selection and causation. Findings failed to support ideas of marriage being protective (through social support), or detrimental (through family roles). Divorce increased distress, with both acute and longer-term components moderated by secondary factors such as childcare and declining socioeconomic status.

Adult↗
PubMed2005

Biological sensitivity to context: I. An evolutionary-developmental theory of the origins and functions of stress reactivity.

Biological reactivity to psychological stressors comprises a complex, integrated, and highly conserved repertoire of central neural and peripheral neuroendocrine responses designed to prepare the organism for challenge or threat. Developmental experience plays a role, along with heritable, polygenic variation, in calibrating the response dynamics of these systems, with early adversity biasing their combined effects toward a profile of heightened or prolonged reactivity. Conventional views of such high reactivity suggest that it is an atavistic and pathogenic legacy of an evolutionary past in which threats to survival were more prevalent and severe. Recent evidence, however, indicates that (a) stress reactivity is not a unitary process, but rather incorporates counterregulatory circuits serving to modify or temper physiological arousal, and (b) the effects of high reactivity phenotypes on psychiatric and biomedical outcomes are bivalent, rather than univalent, in character, exerting both risk-augmenting and risk-protective effects in a context-dependent manner. These observations suggest that heightened stress reactivity may reflect, not simply exaggerated arousal under challenge, but rather an increased biological sensitivity to context, with potential for negative health effects under conditions of adversity and positive effects under conditions of support and protection. From an evolutionary perspective, the developmental plasticity of the stress response systems, along with their structured, context-dependent effects, suggests that these systems may constitute conditional adaptations: evolved psychobiological mechanisms that monitor specific features of childhood environments as a basis for calibrating the development of stress response systems to adaptively match those environments. Taken together, these theoretical perspectives generate a novel hypothesis: that there is a curvilinear, U-shaped relation between early exposures to adversity and the development of stress-reactive profiles, with high reactivity phenotypes disproportionately emerging within both highly stressful and highly protected early social environments.

Environment↗
PubMed1997

Why minority group members perceive or do not perceive the discrimination that confronts them: the role of self-esteem and perceived control.

Self-esteem and perceived control were examined to explain why minority group members sometimes perceive discrimination but, more often, minimize the discrimination. Women (Study 1), and Asians and Blacks (Study 2) reacted to negative feedback after information about the probability for discrimination. Minority group members tended to minimize discrimination and attributed their failure to themselves. By perceiving discrimination as a reason for failure, minority group members protected their performance state self-esteem. In contrast, by minimizing discrimination, they protected their social state self-esteem and maintained the perception of control in the performance and social domains. Results suggest that minority group members minimize discrimination because the consequences of doing so are psychologically beneficial.

Adaptation, Psychological↗
PubMed1997

Perceived burden among caregivers of adults with serious mental illness: comparison of black, Hispanic, and white families.

Differences in perceived burden were investigated among black, Hispanic, and white groups of caregivers of adults with serious mental illness. Controlling for sociodemographic characteristics and caregiving-related stressors, black caregivers tended to report less burden than whites, a result not explained by protective mechanisms (social support, religious involvement, illness attributions). No statistically significant differences were found in perceived burden between Hispanic and white caregivers.

Adaptation, Psychological↗
PubMed1995

A study of the attitudes of nurses to parental involvement in the initial child-protection conference, and their preparation for it.

Fifty-four nurses and 205 other professionals provided data on their attitudes to the involvement of parents in initial child-protection conferences in a northern English city, and on the preparation and training they had received for it. Data were collected before the local authority involved parents and again 1 year later, after parents had been invited to the conferences in four neighbourhood teams. This paper describes the attitudes and training of the nurse respondents at the two points in time, before the authority involved parents and after, and the degree and nature of the training they received in preparation. Overall, attitudes became more favourable over time. There were, however, some abiding concerns; for example, that discussion might be inhibited, and the interests of the child become less central. There were also differences in attitude by agency which reflected an agency orientation and its commitment to the child-protection task. Social workers were initially the most positive and their attitudes the least likely to change. Teachers and police began with the most negative attitudes, but their attitudes changed the most. The nurse professionals occupied the middle ground. There were also differences by agency and over time in the amount of training and preparation received. Nurses were the most likely to be offered training and teachers the least. Inter-agency training, including input from experienced practitioners, was valued.

Attitude of Health Personnel↗
PubMed2006

Women coping with AIDS in Africa: contributions of a contextually grounded research methodology.

The primary objective of this report is to describe a contextually grounded approach to the investigation of coping and psychological functioning in AIDS-sick mothers. Five AIDS-sick women on antiretroviral therapy who had at least one child under 6 years of age living in their households were interviewed. Among the issues that emerged was the complexity of the women's psychological functioning, the fact that they made strategic decisions about disclosure aimed at protecting important social support networks, and that their well-being was dynamically influenced by factors in the home and community. The study provides evidence for the value of a contextual approach when investigating the psychological functioning of HIV positive mothers living in poor high-HIV prevalence communities in developing countries.

Adaptation, Psychological↗