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PubMed2006

Findings from an elder abuse forensic center.

PURPOSE: The first Elder Abuse Forensic Center (EAFC) in the United States was instituted in 2003. People from a variety of disciplines, including Adult Protective Services social workers, law enforcement, the district attorney's office, a medical response team, public guardian deputies, ombudsmen, mental health services, a victim advocate, and a domestic violence expert work cooperatively on cases of elder and dependent-adult mistreatment. Researchers conducted an assessment of the EAFC's impact on the efficiency and effectiveness of the collaboration. DESIGN AND METHODS: Mixed quantitative and qualitative methods included statistical analysis of data from outcome surveys of EAFC collaborators and illustrative case studies developed from case files and structured interviews. RESULTS: Mean survey scores evaluating the efficiency and effectiveness of the collaboration were significantly better than neutral responses. Case studies show efficient and effective case management through cooperation of the collaborating agencies. Survey results clearly support perceptions exemplified in case studies. IMPLICATIONS: An EAFC enhances the efficiency and effectiveness of those who address elder abuse in one community, which in turn leads to improved outcomes. Continued analysis to identify strengths, weaknesses, and cost effectiveness of the EAFC model is ongoing.

Adult↗
PubMed1988

Will radiation control be by reason or regulation?

Following a very brief review of the development of our present radiation-protection philosophy, attention is directed to what the author sees as current problems. The only prognostication will be that at least certain of the problems outstanding or developing today will be among those that will have to be addressed in the coming four decades. For the past six decades, the major effort has been the development of the science and philosophy of radiation biology and its application to protection against radiation hazards, whether real or imagined. For three decades there has been public concern about radiation generally, the core of the problem being inadequate education of the public and the media on the subject. For a little over one decade, there has been rapidly developing growth of tort litigation generally, involving ionizing radiation in particular. These are the three major lines of attention in the radiation-protection area today; between two of them there are already some of the aspects of "the arena." Behind all three lies an overwhelming lack of understanding by, and education of, the public, which shows mostly in the public fetish for absolute safety which, of course, cannot be. These must be the major concerns of the radiation-protection community in the coming four decades.

History, 20th Century↗
PubMed1988

A view from Europe: stability, consistency or pragmatism.

The last few years of this decade look like a period of reappraisal of radiation protection standards. The revised risk estimates from Japan will be available, and the United Nations Scientific Committee on the Effects of Atomic Radiation will be publishing new reports on biological topics. The International Commission on Radiological Protection (ICRP) has started a review of its basic recommendations, and the new specification for dose equivalent in radiation fields of the International Commission on Radiation Units and Measurements (ICRU) will be coming into use. All this is occurring at a time when some countries are still trying to catch up with committed dose equivalent and the recently recommended change in the value of the quality factor for neutrons. In Europe, the problems of adapting to new ICRP recommendations are considerable. The European Community, including 12 states and nine languages, takes ICRP recommendations as a basis and develops council directives that are binding on member states, which have then to arrange for their own regulatory changes. Any substantial adjustments could take 5 y or more to work through the system. Clearly, the regulatory preference is for stability. Equally clearly, trade unions and public interest groups favor a rapid response to scientific developments (provided that the change is downward). Organizations such as the ICRP have to balance their desire for internal consistency and intellectual purity against the practical problems of their clients in adjusting to change. This paper indicates some of the changes that might be necessary over the next few years and how, given a pragmatic approach, they might be accommodated in Europe without too much regulatory confusion.

Europe↗
PubMed1993

Trauma in infants less than three months of age.

We evaluated the characteristics of traumatic injury and risk for subsequent trauma in infants less than three months of age (n = 111). Medical records were reviewed at presentation and one year later. Injury was due to abuse/neglect in 28%, whereas 72% were accidentally injured. Falls were the most common mechanism of accidental injury (67%). The percentage of infants with skull fractures was greater in the abuse/neglect group than in the accidental group (7/31 vs 7/80; P < 0.05) with a tendancy toward more diastatic and multiple skull fractures (6/7 vs 2/7) as well as intracranial hemorrhages (3/7 vs 0/7). More infants in the abuse/neglect group suffered extremity fractures (4/31 vs 2/80; P < 0.05). Hospitalization was more frequent (12/31 vs 8/80; P < 0.001), as was social or protective service intervention (25/31 vs 17/80; P < 0.001), in the abuse/neglect group. The two groups showed no difference in the number of previous emergency department (ED) visits; however, the use of the ED declined significantly in the abuse/neglect group following the trauma (0.81 +/- 1.2 vs 1.5 +/- 2.1 visits; P < 0.05). The abuse/neglect group tended to have a greater number of subsequent traumatic injuries than those accidentally injured. Abuse/neglect should be considered in any seriously injured infant less than three months of age because of the likelihood of subsequent trauma.

Accidental Falls↗
PubMed2003

Antecedents and consequences of work-family conflict: a prospective cohort study.

This study examined both risk factors for the onset of work-family conflict and consequences in terms of need for recovery and prolonged fatigue for men and women separately. Two-year follow-up data from the Maastricht Cohort Study on "Fatigue at Work" (n = 12,095) were used. At baseline, the prevalence of work-family conflict was 10.8% (9.0% in women; 11.1% in men), the cumulative incidence at 1 year follow-up was 5.1%. For men, several work-related demands, shift work, job insecurity, conflicts with coworkers or supervisor, having full responsibility for housekeeping, and having to care for a chronically ill child or other family member at home were risk factors for the onset of work-family conflict, whereas decision latitude and coworker and supervisor social support protected against work-family conflict. In women, physical demands, overtime work, commuting time to work, and having dependent children were risk factors for work-family conflict, whereas domestic help protected against work-family conflict at 1 year follow-up. Work-family conflict was further shown to be a strong risk factor for the onset of elevated need for recovery from work and fatigue.

Adult↗
PubMed2002

A mental model proposed to address sustainability and terrorism issues.

I have assembled traditional ways to think about human needs and power along with empirical data to support a mental model of human values. The hierarchy of needs from the world of psychology and the hierarchy of power from the world of diplomacy provide a structure for the model. The empirical data collected from several nations over the last three decades support the structure. Furthermore, an examination of specific trends in this data for specific values indicates that it is not impossible to achieve a sustainable world driven by sustainable values. A world that will be defined by its successful movement toward the "triple bottom line," a term articulated by John Elkington, is a world in which economic prosperity, environmental protection, and social equity are aligned. To say that the model allows one to address terrorism is based on the assumption that the lack of social equity or the perception of that lack determines the likelihood of terrorism.

Journal Article↗
PubMed2004

Mothers' mental health and infant growth: a case-control study from Rawalpindi, Pakistan.

BACKGROUND: Epidemiological studies in Pakistan show high rates of depression in women, while rates of malnutrition in children are also high. This study aimed to determine whether poor maternal mental health is associated with an increased risk of infant undernutrition. METHODS: Clinic-based case-control study. A total of 172 consecutive infants and their mothers attending for 9-month measles immunization were recruited over a 3-month period. Eighty-two undernourished infants [weight for age below the National Centre for Health Statistics (NCHS)/World Health Organization (WHO) third centile] were matched to 90 controls (weight for age above 10th centile), and their mothers interviewed for mental distress using the Self-Reporting Questionnaire (WHO SRQ-20, a psychiatric screening instrument). Infants' exposure to maternal distress (score > or = 10 on SRQ-20) and other potential risk or protective biological, social, socio-economic and family factors were measured. RESULTS: Mental distress determined by WHO SRQ-20 was associated with increased risk of undernutrition in infants (odds ratio 3.91, 95% confidence interval 1.95-7.86). This association remained significant after controlling for birthweight and social factors. CONCLUSION: Exposure to maternal mental distress is associated with undernutrition in 9-month infants in urban Pakistan. These mothers may represent a group whose children are at higher risk of ill health, and potentially be a specific target for advice on infant care. Early recognition and treatment of mental health problems in mothers may help reduce morbidity and mortality rates in children.

Case-Control Studies↗
PubMed2000

Unemployment and psychological distress one year after childbirth in France.

STUDY OBJECTIVE: To analyse the relation between unemployment and the psychological distress of mothers one year after childbirth. DESIGN: Multicentric survey concerning births occurring between September 1993 and July 1994. SETTING: In France: two maternity units in the Parisian area and one in Champagne-Ardennes, in the east of France, comprising both urban and rural areas. PARTICIPANTS: Primipara and secondipara women were interviewed three times: at birth by a face to face interview, five months and 12 months after the birth, by postal questionnaires, with a 83% response rate for the two postal questionnaires. The analysis includes 632 women who answered all three stages of the survey. MEASUREMENTS: Psychological distress was mainly assessed one year after birth by the 12-item General Health Questionnaire. RESULTS: After adjustment for unwanted pregnancy, marital conflicts, marital status, hospitalisation of the baby during the last year, lack of confiding relationship, depressive or anxious troubles before pregnancy, age, educational level and parity, unemployed women had an excess of psychological distress compared with employed women (OR = 1.87; 95% CI = 1.12, 3.13). The ratios for housewives were very close to those of employed women. Among the unemployed women, 60% had recently been without a job, since a few months before or after the birth. An excess of psychological distress among unemployed compared with employed women was observed in all social groups defined by the current or last occupation, but with various extents. Psychological distress was specially linked to the employment status in the group of women with the more qualified occupations. CONCLUSION: Even after a birth, when women are very much involved in their maternal role, those seeking a job have worse mental health than those in a stable situation, either employed or housewives. In France, the unemployment rate among young women is high. It is specially important that social regulations protecting employment during and after pregnancy are adequately applied. Employers, legislators, such as medical doctors, have to be aware to this situation.

Adult↗
PubMed2006

Depression in Irish migrants living in London: case-control study.

BACKGROUND: There is evidence that Irish migrants in Britain have higher rates of depression and suicide than other minority ethnic groups. AIMS: To examine the association between poorly planned migration and depression in Irish-born people living in London. METHOD: A sample of 360 Irish-born people was recruited from 11 general practices into a case-control study. Participants were interviewed using standardised measures, including the Beck Depression Inventory (BDI). We calculated the odds ratio for any association between depression and eight questions on preparation for migration. RESULTS: Poorly planned migration was associated with subsequent depression in Irish-born people living in London (OR=1.20, 95% CI1.06-1.35). The odds of depression were increased by a factor of 20% for each additional negative answer to eight questions on preparation for migration. Positive post-migration influences such as adequate social support protected some against depression. CONCLUSIONS: Depression in Irish-born people living in London is associated with poorly planned migration. However, this effect can be modified by experiences following migration.

Adult↗
PubMed2002

Community involvement in the ethical review of genetic research: lessons from American Indian and Alaska Native populations.

The National Bioethics Advisory Commission has proposed that regulatory oversight for research with human subjects be extended beyond the protection of individual research participants to include the protection of social groups. To accomplish this, the commission recommends that investigators and ethics review boards a) work directly with community representatives to develop study methods that minimize potential group harms, b) discuss group implications as part of the informed consent process, and c) consider group harms in reporting research results. We examine the utility of these recommendations in the context of research with American Indian and Alaska Native communities. Because much attention has been given to the question of how best to consult with members of these communities in the design and conduct of research, we believe it behooves investigators to consider the lessons to be learned from research involving American Indians and Alaska Natives. After describing several difficulties surrounding the application of the commission's approach to these research contexts, we propose a research agenda to develop best practices for working with local communities in the ethical assessment of epidemiologic and environmental health research.

Alaska↗
PubMed2006

Nurses respond to healthcare restructuring: the transformation of the Massachusetts Nurses Association.

The most recent period of Massachusetts healthcare system reorganization began in the early 1980s. In part, this has been a response to soaring healthcare costs, countering them with diminished reimbursements. To decrease labor costs and survive in an increasingly competitive and market-driven healthcare environment, hospitals downsized and laid off nursing staff. Patient care and safety has concomitantly suffered. These efforts severely challenged nurses' status. Radicalized rank and file members of the Massachusetts Nurses Association mobilized against the association leadership's weak efforts to protect nurses' social and economic interests and the deteriorating quality of care. They transformed an association whose main focus was supporting nursing's professional image to one which became an activist labor union of professional workers. The history of this often contentious transformation is presented here within the context of these healthcare system changes. The MNA's successes and pending challenges within the Massachusetts healthcare system are also discussed.

Hospital Restructuring↗
PubMed2003

The role of official veterinary services in dealing with new social challenges: animal health and protection, food safety, and the environment.

The authors describe the role of Veterinary Services in dealing with developments in society and the challenges they present. In an increasingly globalised world, in which there are new methods of production, a new and changing relationship between humans and animals and increasingly complex and global problems, the protection of public health and the safety of the environment in which people and animals live require new skills, new knowledge and new technical-scientific responses. Official Veterinary Services are responsible for maintaining hygiene and animal health standards in primary and secondary production and ensuring fair trade. To achieve this, Veterinary Services must ensure that their organisational structures meet internationally recognised quality assurance standards.

Animal Rights↗
PubMed1990

Stigmatization: experiences of persons with acquired immune deficiency syndrome.

The purpose of this study was to understand the meaning that being stigmatized has for persons with Acquired Immune Deficiency Syndrome (AIDS). The research question for this investigation was, What is the perception of stigmatization as experienced by persons with AIDS? Phenomenology provided both the theoretical framework and the method for this study. The sample consisted of 10 homosexual men contacted through a New Orleans hospice, home health nurses, the investigator's own personal contacts, and referrals from men who were in the project. Participants were asked open-ended questions pertaining to changes in their relationships with others since diagnosis, changes in self-esteem, and examples of prejudice and discrimination. Interviews were audiotaped, transcribed verbatim, and analyzed using a qualitative approach. The phenomenon of stigmatization emerged as experiences of rejection and protection in social interactions.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Social cognitive predictors of sun protection intention and behavior.

The authors investigated sunbathing behavior and intention prospectively using the Theory of Planned Behavior (TPB). Before summer, 85 young adults who intended to sunbathe completed a TPB questionnaire. After summer; 46 of them completed a second questionnaire about their summertime sunbathing behavior The proposed model was successful in predicting both behavior and intention to use sun protection, with 45% of the variance of self-reported sunscreen use and 32% of the variance in intention explained by the TPB. Items designed to measure self-efficacy and perceived control loaded onto different factors and demonstrated discriminant validity. Self-efficacy predicted both intention and behavior (after controlling for all other TPB variables), but perceived behavioral control did not. The authors discuss the implications of the findings for potential interventions to improve sun protection behavior

Adult↗