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PubMed1986

Psychosocial aspects of the multidisciplinary assessment of osteoarthritis.

The social network, family functioning, and health-protective behaviors of 77 osteoarthritis patients treated for 12 weeks by a multidisciplinary team were assessed. Measures included assessments of social network using components of the OARS, family satisfaction using the APGAR, family cohesion and adaptability using the FACES II, alcohol abuse using the CAGE, and indicators of health-protective behaviors. Participants were generally socially active, socially integrated, and satisfied with family relationships. Reported health-protective behaviors were low, indicating the need for assistance in improving preventive health practices. Few of the patients appeared to be at risk for alcoholism. Improvements in pain and activities of daily living were not correlated with changes in social functioning. Social functioning appeared to be relatively stable and not altered by short-term improvements in osteoarthritis. Social workers can play an important role in facilitating individual and family adjustment to the limitations imposed by osteoarthritis and in the rehabilitation process for osteoarthritis patients.

Adult↗
PubMed2005

Can current physical activity act as a reasonable proxy measure of future physical activity? Evaluating cross-sectional and passive prospective designs with the use of social cognition models.

BACKGROUND: The standard methodological approach for evaluating social cognitive theories when predicting physical activity behavior is the passive prospective/longitudinal survey design. Although this design is logical, a cross-sectional design may be a cost-effective alternative if the relationships between social cognitive constructs and physical activity are relatively stable. The purpose of this study was to evaluate the utility of a concurrent measure of physical activity used in a cross-sectional design in comparison to the standard prospective measure. METHODS: This study included two 6-month prediction time-periods, between 1997 and 1998, for the purpose of analysis replication, and the theory of planned behavior, the transtheoretical model, protection motivation theory, and social cognitive theory as the models of interest in a population sample (N = 703). RESULTS: Results showed trivial (69% of tests; q < 0.10) to small (31% of tests; q = 0.11-0.18) differences in the correlations between social cognitive constructs and vigorous physical activity occur when using a cross-sectional or prospective design. The cross-sectional design estimated slightly larger coefficients than the prospective design. CONCLUSIONS: It appears that a measure of concurrent physical activity included in a cross-sectional design can act as a reasonable proxy measure of future behavior measured in a passive prospective/longitudinal design. These findings support the use of cross-sectional designs when researchers seek a standard correlational investigation of physical activity and social cognitive constructs with the possibility that coefficients may be slightly biased upwards.

Adult↗
PubMed2003

Association of parental involvement and social competence with school adjustment and engagement among sixth graders.

To identify factors associated with school adjustment and engagement, 1,267 sixth graders in four middle schools in one US school district were surveyed at the beginning (Time 1) of the school year, 1,081 (85.3%) of whom were surveyed again at the end (Time 2). School adjustment was higher for girls than boys at both Time 1 and Time 2 and the decline was less for girls than boys and Whites than Blacks. School engagement also declined significantly from Time 1 to Time 2, but no differences existed among subgroups. In multiple linear regression analyses, female gender, school engagement, social competence, parental involvement, and depressive symptoms (negative association) assessed at Time 1 were associated with school adjustment assessed cross-sectionally at Time 1 and prospectively at Time 2. Social competence and parental involvement assessed at Time 1 were associated with school engagement assessed at Time 1 and Time 2. Findings confirm the decline in school adjustment and engagement during middle school and provide evidence that parental involvement and social competence may be protective against declines in these variables.

Adolescent↗
PubMed2002

[A multi-team case-control study on the effects of psychosocial stress to overall health].

OBJECTIVE: To explore the quantitative relationship between the intensity of psychosocial stress and the degree of overall health damages. METHODS: A multi-group case-control study was designed and implemented. The cases included two groups of out-patients (177) and in-patients (214) in a hospital in Jianyang city, and controls (587) were from the follow-up cohort in the same city. Three groups were studied on the following contents: general demographic characteristics, psychosocial factors and the degree of health damages including mental, physical, and social status. Major statistical analyses were as follows: ranks test, ANOVA, cluster analysis, multinomial logistic regression and ordered-logit regression. RESULTS: Ordered-logit regression model showed that the odds ratio of negative life-events on degree of health damages was 1.335 (P < 0.01). This result showed that there was a positive dose-effect relationship between the negative life-events score and overall health damages. The utility of social support to overall health had protective effect (OR = 0.513). CONCLUSION: Negative life-events were the major risk factors to overall health, and there was a dose-effect relationship between negative events and health damages. Function of social support played a protective factor for health.

Analysis of Variance↗
PubMed2003

[Recovery of intersubjectivity and empathy in schizophrenics: through a characteristic type of friendship "frolicking"].

The author has noticed a characteristic form of close, frolicsome friendship between recovering adolescent schizophrenic patients. It occurs in groups of young patients in a psychiatric clinic and in a day-care institution. Through this type of friendship, their intersubjectivity, ability for empathy and human relations develop, essential changes for the amelioration of schizophrenia. It is characterized by 1 A mutual relationship on equal terms with another schizophrenic patient of the same sex and generation; particularly close friendship between two patients, or sometimes several patients who form a group, spending much time together. 2 Playful, childish behavior, jokes and jests; Patients laugh and make others laugh, playing together. 3 Touching the friends' bodies and coordinated playing such as dancing and singing together. 4 Chatting and having common interests, along with sharing various experiences. 5 Enjoyment with so much energy that sometimes, as in a gang, social norms are contravened. 6 Being a transient phenomenon that ends naturally after a certain period. Through such friendship, the adolescents show mental growth compared with their premorbid state. They come to sympathize with others' feelings and willingly cooperate. Their social relationships and spheres of activity expand, and spontaneity and self-esteem become improved. They come to assert themselves adequately, tolerate stress, and conform to social norms. Moreover, they advance to developing a purpose. e.g. work. To be able to have empathy through friendship with those of the same sex and generation is a basic developmental theme generally seen in childhood and pre-adolescence. Such friendship between the patients studied represents benign regression in such a developmental period. This type of friendship is characterized by a frolicsome and playful atmosphere. Frolicking by means of jokes, jests and body-touching, and play with coordinated acts lead to the sharing of emotions and development of their intersubjectivity, the latter improving the person's empathy, spontaneity and self-esteem. This type of friendship appears in patients in their teens or twenties once a certain period has passed after the disappearance of positive symptoms. Its typical course is seen in teen-agers who show a premorbid personality deviation such as difficulty in establishing social relationships. No particular tendency as to gender or family type was found. Therapists should provide the opportunity and setting for this type of friendship to develop. Adolescent schizophrenics can gather together and are open-mindedly accepted in such a setting, which has an informal component where therapeutic staff may not interfere in this playful atmosphere. Therapists should act as third persons, once friendly play begins, after the introductory period during which the therapists' protection and limits on social stimulation are needed. It is desirable to appreciate patients' friendships and self-help, offering a rehabilitation program and adequate support, as they step forward to the future.

Adolescent↗
PubMed2000

Influence of social network on occurrence of dementia: a community-based longitudinal study.

BACKGROUND: Few data are available on the effect of social ties on dementia development. This study explored whether single social network components and different degrees of the social connections affect dementia incidence. METHODS: A community-based cohort of 1203 non-demented people, living at home in the Kungsholmen district of Stockholm, Sweden, and who had good cognition, was followed for an average period of 3 years. On the basis of medical and psychological data, 176 patients were diagnosed with dementia according to the criteria of the third edition revision of the Diagnostic and Statistical Manual of Mental Disorders. Information on social network was obtained by personal interview by trained nurses at baseline. The covariates included in the analysis were age, sex, education, cognitive and functional status, depressive symptoms, and vascular diseases. FINDINGS: Those individuals living alone, and those without any close social ties, both had an adjusted relative risk for developing dementia of 1.5 (95% CI 1.0-2.1 and 1.0-2.4, respectively). Compared with married people living with someone, single people and those living alone had an adjusted relative risk of 1.9 (95% CI 1.2-3.1). Infrequent contacts with network resources did not increase the risk of the disease if such contacts were experienced as satisfying. When all components were combined in an index, a poor or limited social network increased the risk of dementia by 60% (95% CI 1.2-2.1), and a significant gradient was found for the four degrees of social connections (p=0.0009). INTERPRETATION: An extensive social network seems to protect against dementia. Confirmation of this finding and further investigation to clarify the mechanisms are worthwhile due to the implications for prevention.

Aged↗
PubMed1985

An analytic typology of disclaimers, excuses and justifications surrounding illness: a situational approach to health and illness.

An analytic typology of disclaimers, excuses and justifications is developed to demonstrate how illness is possible within our everyday social situations. Beginning with the concepts of the 'disclaimer' from Hewitt and Stokes, and the 'excuse' and 'justification' from Scott and Lyman, these concepts are extended and reconceptualized to apply to circumstances where signs and symptoms of illness compromise and disrupt role performance and situational participation. Using a situational perspective on health and illness, the presentation of a disclaimer, excuse or justification is seen as a means of allowing the symptomatic individual to 'drift' in and out of illness while protecting his and others' social identity, the integrity of the social situation and the individual's health status.

Attitude to Health↗
PubMed1999

The "mad" vs. the "bad" revisited: managing predatory behavior.

Ever since the Englightenment, western democracies have maintained separate institutions for the "mad" and for the "bad." For the mad they provided protection and treatment, and for the bad, deterrence and punishment. During the past decade, however, increasing social conservatism and the apparent failure of the criminal justice system have resulted in a series of changes in social policy. In order to protect the public adequately from repeatedly violent predators, legislation has been introduced in several states that remands those predators to mental institutions on completion of their prison terms. Challenges to this legislation, based on ex post facto, double jeopardy, and civil rights considerations were effectively dismissed by the U.S. Supreme Court in Kansas v Hendricks in June, 1997. An effect, however unintended, of upholding these laws and of policy changes leading up to them, is that they have effectively blurred the separation between mad and bad. This paper details the following: 1) the events that have led to these changes in policy and law; 2) the preparations being made in New York State's mental health system to prepare for managing such predators when and if such laws are enacted; 3) the dangers and drawbacks these changes have brought in states where they have already been legislatively mandated; and 4) suggestions for alternatives that would reaffirm the separation between mad and bad.

Adult↗
PubMedDate not supplied

Marital status, gender roles, stress, and health in the elderly.

A model of the relationship between the social context effects of marital status and gender role differences in health was tested in a sample of noninstitutionalized elderly. The conceptual model assumed that (a) marital status is a social context; (b) social contexts give rise to social interactions; (c) social interactions result in the assumption or modification of gender roles; and (d) gender roles determine the behavior of elderly individuals with regard to health, stress, coping, and social support. A random telephone survey of 6,585 households in six northeastern states resulted in a sample of 900 elderly 65 years of age or older. Hierarchical regression analysis was used to test the main effects, the joint effects, and the combined effects of gender and marital status on the independent variables as they related to health. Findings suggested that of the four marital contexts studied (married men and married women and unmarried men and unmarried women), married women were in the poorest health and most vulnerable to stress. For them, social support in terms of both number of confidantes and access to helping networks was not protective. These findings suggest that social context affects elderly women's health. The potential for expanding theories of women's health to include the social conditions in which they live is discussed.

Age Factors↗
PubMed1989

Social ties and survival among the elderly in Tampere, Finland.

The association between social ties and survival was assessed using a stratified sample of 1060 elderly aged 60-89 years in the city of Tampere, Finland. During the 6.5-year follow-up, 240 men and 153 women died. Compared with married men, the death rate ratio among unmarried men was 1.7 and among widowers 1.2. The respective ratios for women were 1.2 and 1.2. Vicinity of children, living alone, loneliness, social contacts, and social participation were used as indicators of social ties. Men and women were analysed separately. None of the indicators were significant predictors of survival in proportional hazard analyses, after adjusting for age, perceived health, functional ability and occurrence of a disabling disease at baseline. The relative hazards ranged between 0.85 and 1.38, and all 95% confidence intervals included unity. However, when social participation was entered into the models as a continuous variable, it was strongly associated with increased survival in both sexes. Social participation is probably not protective as such, but it may rather reflect way-of-life, which is characterized by social competence or 'control of destiny'.

Activities of Daily Living↗
PubMed2001

Cost-benefit analysis of social work services in the emergency department: a conceptual model.

OBJECTIVE: To describe an economic model for formal cost-benefit analysis of emergency department (ED)-based social services. METHODS: The varied monetary costs and benefits associated with ED-based social work services were projected for three hypothetical levels of ED volume (30,000, 60,000, and 90,000 patients/year). Primary benefits included the prevention of return ED visits, the prevention of "social" hospital admissions, and the protection of doctor and nurse time. The primary cost was salary support for full-time social work staffing. Sensitivity analysis was performed to account for varying estimates. RESULTS: For a small-volume ED, total benefits to offset costs ranged from $43,869 to $81,504, yielding a net cost of $99,936 up to $137,571 for full-time social work coverage. For a moderate-size ED, total benefits ranged from $87,660 to $162,930, yielding a net cost of only $18,510 on the high end of the sensitivity analysis, and $87,668 on the low end. For a large-volume ED, total benefits ranged from $131,529 to $247,434, yielding a net cost of $49,911 on the low end of the sensitivity analysis, but a net benefit of $65,994 on the high end. CONCLUSIONS: Dedicated social work staffing of EDs may yield net economic benefits, especially in large urban centers. Moderate-size EDs may almost "break even" in economic terms, and small EDs may realize a net cost, but in either case, the cost of social services can be significantly offset by decreased utilization of hospital and ED services, and by more efficient use of medical staff time.

Cost-Benefit Analysis↗
PubMed2003

A qualitative study of the psychosocial implications of lipodystrophy syndrome on HIV positive individuals.

OBJECTIVES: To investigate the psychosocial impact of lipodystrophy on the lifestyles of HIV positive patients on highly active antiretroviral therapy (HAART). METHODS: In-depth interviews were conducted with 14 HIV positive patients on HAART at an outpatient sexually transmitted infections (STI) and HIV clinic in central London. Qualitative data from interview transcripts were analysed using grounded theory to elicit key categories and subcategories. RESULTS: Three main themes relating to lipodystrophy emerged: effect on the individual; impact on the social world of the individual; responses of the individual. Lipodystrophy had physical and psychological effects, ranging from bodily discomfort to low self esteem and depression. Owing to its physical manifestations it was viewed as a visible marker of HIV disease. At the level of social functioning, lipodystrophy led to problems with personal and family relationships, although having a partner was protective. Individuals reported narrowing their social world, in some cases to degrees of social isolation. Individual responses included changes in diet, increased exercise regimes, steroid use and plastic surgery (mainly collagen injections to the face). For those who had experienced serious illness related to HIV, there was a more sanguine acceptance of lipodystrophy as an unfortunate consequence of longevity and drug therapy CONCLUSIONS: Health professionals need to address the psychosocial implications of lipodystrophy, including the ways in which it may affect different groups and their adherence to therapy. Formative evaluations are needed to assess the potential for targeted interventions.

Adult↗
PubMed2002

[Evaluation of tetanus vaccine coverage in rural society].

The Liège University Department of General Practice and the Association of the General Practitioners of Sprimont (Belgian municipality) have jointly drawn up a study protocol named "Evaluation of anti-tetanus cover in rural society". The aim of this epidemiological search program was to answer the 2 following questions: What is the status of anti-tetanus cover among the rural population, according to age, sex and social classes? Is vaccine protection influenced by leisure activities (sport practice, gardening and animal farming at a small scale)? We received 790 answers out of 960 forms sent in a at random selected population (82.3%). A sampling classification has been done by the general practitioners, who have determined 3 categories of patients: unprotected patients (no vaccination for the last 10 years), patients in the process of vaccination, protected patients. Protected patients represent 51.8% of the population. Surprisingly enough, more than 45% of that rural population are not protected. This study clearly shows that two factors highly influence the vaccination cover against tetanus: age (elderly are less protected) and sex (women are always less protected than men). It also emerges from our analysis that the nature of the population's professional activities does not influence the protection rate. In contrast, leisure activities seem to have a favourable impact on the vaccination rate, sport leading to a better protection for both sexes. It is also true in the case of gardening practice, frequent in rural environment. We must then be careful to reach optimal vaccination among a population with an increasing life expectancy, therefore with more and more elderly people, and we must be careful with vaccination among females, presently less protected. The role of the family doctor is paramount to carry out that mission.

Activities of Daily Living↗
PubMed2003

Which individuals with affective symptoms seek help? Results from the Zurich epidemiological study.

OBJECTIVE: Several factors influence whether individuals with affective disorders seek help. The Zurich cohort study provides an opportunity to explore patient-based factors without confounding with problems of access. This study aims to identify features which predict help-seeking behaviour in symptomatic individuals and to explore failure of help seeking in those who did not. METHOD: Characteristics of currently symptomatic 40-year-old individuals in a stratified epidemiological sample were tested against help-seeking behaviour using bivariate statistics and logistic regression. Individual predictors were identified and interaction effects tested. RESULTS: Thirty-one per cent of the 364 subjects sought help in the preceding year. Past treatment and living alone were significantly associated with treatment. Total number of symptoms and several individual symptoms correlated with treatment in the bivariate analyses but regression analysis identified "unfounded self-reproach" and "hopelessness" interacting with social support to predict the best treatment. CONCLUSION: Social support is strongly protective against needing help in the presence of distressing affective symptoms unless these symptoms become elaborated into conclusions about their meaning and prognostic significance.

Adult↗
PubMedDate not supplied

Risking for protection: discourses around 'safe sex' among Chilean, Turkish and second-generation Greek women living in Melbourne, Australia.

The aim of this study was to identify the ways in which women from Turkish, second-generation Greek and Chilean backgrounds living in Melbourne, Australia, understand risks to their sexual health with a focus on STDs including HIV/AIDS. Data were derived from in-depth qualitative interviews with 20 women from each ethnic group (N = 60). Interviews were guided by a theme list, conducted in the woman's language of preference, tape-recorded and fully transcribed. Transcripts were double coded for key themes and analysed using ethnographic content analysis. The key findings are that for many women, reducing the risk of STDs to protect their physical health introduces risks to their social health and to the well-being of their family and community. Thus, women place priority over the protection of their social health as opposed to their physical health. Despite specific cultural differences in understandings of sexual health risks and illnesses, all women shared gendered commonalities in the ways in which they contextualise STDs within the wider context of social relationships and their everyday life. We conclude by arguing for interventions that specifically take into account social models of risk in STD and HIV/AIDS prevention and we consider the practical implications of this for harm reduction strategies in multicultural societies such as Australia.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The psychosocial work environment of physicians. The impact of demands and resources on job dissatisfaction and psychiatric distress in a longitudinal study of Johns Hopkins Medical School graduates.

This study examines the relationship between the psychosocial work environment and cross-sectional job dissatisfaction and prospective psychiatric distress in a cohort of Hopkins Medical School graduates in midcareer. An instrument was constructed consisting of five scales: psychological job demands, patient demands, work control, physician resources, and coworker support. The results of scale reliability and factor analysis are presented. Higher job demands were found to be associated with increases in job dissatisfaction and psychiatric distress and greater resources were associated with decreased levels of dissatisfaction and distress. In multiple-regression analysis, only work control and social support were found to be independently associated with dissatisfaction and distress. These results suggest that the presence of control and social support at work protects physicians from developing job dissatisfaction and psychiatric distress.

Adult↗
PubMed2002

Alexithymia, social support, psycho-social stress and mental health in a female population.

BACKGROUND: We wanted to look into what impact the level of alexithymia, as assessed by the Toronto Alexithymia Scale with 20 items (TAS-20), has on presence of social support and vulnerability for psycho-social stress assessed as occurrence of serious life-events, in an all-female population. METHODS: A total of 1032 of females employed in a child-care programme in Sweden participated. They were asked to fill in a questionnaire and 864 (83.6%) delivered complete tests. RESULTS: The prevalence of alexithymia was 7.9% and there were significant associations between high TAS-20 scores with low level of education. In addition, this assessment showed significant relationships between global TAS-20, as well as the sub-factors of TAS-20 and lower social support. Having a low level of social support was found to be 3.5 times more common in the part of the population who was alexithymic. It was also 2.6 times more common for the alexithymic part of the population not to have someone to turn to. Alexithymics with low support and no life events had overall mean scores on all the three variables presenting them as worse off from a mental health point of view. When life events were present alexithymics remained worse off than non-alexithymics even when a higher level of support was in place. There was a significant direct protective (salutary) effect of social support found for social disability in the alexithymic population. CONCLUSION: Alexithymics in this study showed a lack of social support and a proneness to high levels of negative emotion and to social distress.

Adult↗
PubMed1990

Long-term follow-up study of children developmentally retarded by early environmental deprivation.

In 1972, two children representing a case of severe developmental retardation were discovered and taken into custody. The children, an older sister (referred to as F) and a younger brother (referred to as G), were found to have achieved no more than the physical and mental age level normal to children 1 year of age or less, in spite of their actual respective chronological ages of 6 and 5. Investigation revealed that the children's developmental retardation was due both to extreme social isolation and to complex deprivation. By following their sensorimotor, linguistic, cognitive, and socio-emotional development from the time of discovery to the date of this writing, we have found that their physical and motor development or recovery has proceeded smoothly, whereas their linguistic and cognitive development has continued to show such weaknesses as defective functioning of internal speech (Vygotsky, 1962) and poor ability to deal with abstract, linguistic subjects. F and G have continued to exhibit a tendency toward undersocialization, but this has at times been rather a positive factor in the process of attaining ego identity during adolescence, especially for G, serving to protect him from unreasonable social pressures to conform to group behavior. In combination with other cases of severe deprivation, the case of F and G holds some interesting implications for theories of human development, particularly the notion of critical periods.

Child↗