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PubMed2002

Place and personal circumstances in a multilevel account of women's long-term illness.

This paper investigates geographical variations in women's reports of limiting long-term illness in terms of individual inequalities and the contribution of area characteristics among wards and county districts. We use multilevel modelling of linked census data from the Office for National Statistics Longitudinal Study for England and Wales. We follow a random sample of 76.374 women aged between 16 and 45 at the time of the 1971 Census for 20 years to observe their reported limiting long-term illness (LLTI) at the 1991 Census. Car and home ownership were useful markers of social and material advantage, apparently protecting against the risk of reporting LLTI. Migration into the South-East region appeared beneficial, but otherwise there was little difference between those who moved home and those who did not. Differences between county districts persist after adjustment for individual circumstances (education and ethnicity), but almost all of these differences are explained by the social profile of wards in these areas. Geographical differences in LLTI are not, therefore, entirely explained by the distribution of individual characteristics: a woman with the same history may face a different risk of illness in different kinds of area. For women, the social composition of the locality (using the ward as a proxy) is more relevant than the broader economic and industrial classification of the surrounding county district, which is more important for health inequalities among men.

Adolescent↗
PubMed1998

Risk and protective factors for children's substance use and antisocial behavior following parental divorce.

Social networks and personal resources were examined as risk or protective factors for substance use and antisocial behavior in children five years after parental divorce. Children of divorce reported significantly more substance-using friends and less use of coping and social skills than children whose parents had not divorced. Findings suggest the importance of focusing on substance use as well as mental health outcomes in preventive interventions for children of divorce.

Adaptation, Psychological↗
PubMed1992

Childhood chronic illness as a family stressor.

Investigated the impact of childhood chronic illness within a family context. We interviewed 30 mothers of 6- to 14-year-old children with asthma or diabetes and 30 mothers of healthy children of the same age and sex. Family functioning, extrafamilial social support available to mothers, and child life stress events were examined in relation to the children's psychological adjustment and illness events. The mothers of asthmatic children reported a greater number of internalizing behavior problems in their children, perceived their own social support as less adequate, and reported a greater number of stressful events. Regression analyses demonstrated that family functioning, maternal social support, and chronic illness were significantly related to the psychological adjustment of the child. The importance of family functioning and resources available to the family, such as social support, are discussed as protective influences in coping with childhood chronic illness.

Adaptation, Psychological↗
PubMed1986

Psychosocial support and change in the health status of physically disabled people.

Evidence is presented on the relationship between psychosocial support (social contact and emotional intimacy) and changes in health status (physical, psychosocial and emotional functioning) experienced by 583 adults age 45-75 years living at home with a preexisting physical illness. Data were used from a panel study of physically disabled adults in London, England to provide a test of the buffer and direct effects hypotheses concerning social support and adverse life events. Controlling for age, sex and initial level of health status, the analyses showed that a low level of social contact was associated significantly with deterioration in psychosocial and emotional functioning only in the presence of adverse life events. A similar but non-significant pattern existed for physical functioning. A high level of social contact had a more protective effect on the physical functioning of respondents with arthritis or heart trouble who also reported depression, except among women age 45-64. Level of emotional intimacy was not a significant influence on reported health status change. Confiding relationships do not appear important for adults with preexisting illnesses who are not at significant risk of developing stress-related conditions. Social participation outside the home would help to reduce deterioration in psychosocial and emotional functioning, important outcomes for improving and maintaining quality of life.

Aged↗
PubMed2003

The effect of social relations with children on the education-health link in men and women aged 40 and over.

Accumulated evidence demonstrates a strong relationship between socioeconomic status (SES) and health. Our examination of this relationship focuses on education, an established indicator of SES, and tests whether social relations, particularly with children, mediate and/or moderate the education-health link for middle-aged and older parents. The data are drawn from a regionally representative sample of adults (aged 40-93) in the Detroit area, USA. All analyses are stratified by gender (N=males: 330; females: 468). A series of multiple regression analyses were performed to test whether social relations mediate the association between education and health. Although analyses revealed no mediation effect, both men and women with less education were found to have smaller social networks. Women with more education confided less in their children than women with less education did. A series of hierarchical regression analyses were performed to test whether social relations variables moderate the relationship between education and health. Separate analyses by gender indicated that men, but not women, with less education who had larger networks and who perceived emotional, financial and sick care support to be available from a child had lower scores on a health problems index. Findings indicate that the health of lower-educated men in the presence of key social supports parallels the advantaged health status of men with higher levels of education. These findings suggest that social relationships may be a protective factor for the health of men in the lower socioeconomic strata.

Adult↗
PubMed2005

Religiosity and the socioemotional adjustment of adolescent mothers and their children.

This study assessed the impact of religiosity on the socioemotional and behavioral outcomes of 91 adolescent mothers and their offspring over 10 years. Religiosity was defined as involvement in church and contact with and dependence on church officials and members. Mothers classified as high in religious involvement had significantly higher self-esteem and lower depression scores, exhibited less child abuse potential, and had higher occupational and educational attainment than mothers classified as low in religious involvement; differences remained when multiple factors, such as stress and grandmother support, were held constant. Children with more religious mothers had fewer internalizing and externalizing problems at 10 years of age, with maternal adjustment mediating this relationship. Religiosity, through increased social support, served as a protective factor for teenaged mothers and their children.

Adolescent↗
PubMed2000

[Experiencing violence in childhood--risks and health sequelae].

OBJECTIVES: Descriptive study on health outcomes, co-morbidity, severity and social context in child abuse and neglect. METHODS: Cross-sectional study of consecutively incoming cases in eleven German Child Protection Centres between January and July 1997 using a standardised survey instrument. RESULTS: We report on 263 children from 251 families. The majority of children was less than ten years old, 63% were girls, 37% boys. Of all children, 134 had suffered sexual abuse with physical contact, 20 sexual abuse without contact, 77 physical abuse, 62 emotional abuse and 99 neglect (multiple responses were allowed). The overlap between various types of abuse was considerable: many children had suffered more than one, a quarter more than two types of abuse. The majority of cases was classified as either severe and/or chronic. Most children and youngsters suffered emotional distress or posttraumatic stress, long-term consequences of physical injuries were less common. Intra-familiar relationship problems and emotional distress of the care-giver had greater impact on the risk for abuse or neglect compared to socioeconomic risk factors. In 55% child protection workers documented a disability in social and emotional development, in a quarter of children developmental retardation. CONCLUSIONS: The current, exclusive classification of types of abuse and neglect does not adequately describe the complexity of childrens' experiences of intra-familiar violence. Future research should be oriented towards the physical, emotional and social consequences of child maltreatment and use multifactorial designs to capture the complex aetiology and multiple acts and omissions responsible for the distress and injuries. Prospective studies are important to assess specific effects of child abuse and neglect on child development.

Adolescent↗
PubMed2001

Doctor-patient relationships in global society. Informed consent in dentistry.

The concept for initiation of treatment only after the explicit consent of the patient, based on preliminary information, is the most important element determining the relationship between patient and doctor nowadays. The application of this concept in dentistry and its inclusion in the professional documents regulating these relationships needs more comprehensive and modern conditions-relevant analysis of ethical, legal and professional aspects of the problem. The purpose of the study was to define the modern view of informed consent and its application in dentistry in different social environment. The general and specific features of the evolution of the problem and the social practice in Bulgaria, The European Community and Northern America are discussed in the context of the global tendency for free movement of patients and mutual recognition of professional qualification. The results suggest that despite the different degree of social and economical development in different countries the interest in the problem grows significantly and harmonization of legislation for health protection is based on the new social decree in the construction of doctor-patient relationships. It is expected that the comparative studies in this field will promote the improvement of dentists' training and improvement of scientific and expert exchange in solving problems of patents' rights and professional ethics.

Dentist-Patient Relations↗
PubMed1994

Psychological effects of torture: a comparison of tortured with nontortured political activists in Turkey.

OBJECTIVE: The aim of the study was to investigate the long-term effects of torture in a group of former political prisoners. METHOD: The study was carried out in Istanbul, Turkey, where 55 Turkish political activists who had been tortured were compared with a closely matched group of 55 activists who had not been tortured. The Structured Clinical Interview for DSM-III-R, the Semistructured Interview for Survivors of Torture, and other self-rated and assessor-rated measures of anxiety, depression, and posttraumatic stress disorder (PTSD) were used. The tortured and the nontortured activists were similar in age, sex, marital and socioeconomic status, political ideology, political involvement, stressful life events other than torture, and other features. RESULTS: The torture survivors reported an average of 291 exposures to a mean of 23 forms of torture. The mean length of their imprisonment was 47 months. The survivors of torture had significantly more symptoms of PTSD and anxiety/depression than the nontortured comparison subjects, although their PTSD symptoms were only moderately severe and their general mood was normal. Despite the severity of their torture experiences, the survivors had only a moderate level of psychopathology. CONCLUSIONS: The results suggest that torture has long-term psychological effects independent of those related to uprooting, refugee status, and other traumatic life events in a politically repressive environment. Prior knowledge of and preparedness for torture, strong commitment to a cause, immunization against traumatic stress as a result of repeated exposure, and strong social supports appear to have protective value against PTSD in survivors of torture.

Adult↗
PubMed1997

Relationships between social support, social coping and life events in the relapse of schizophrenic patients.

The vulnerability-stress model for schizophrenia posits that relapses are at least partly determined by interacting triggering and protecting psychosocial factors. This study examined social support and general coping style in 42 consecutively admitted DSM:III schizophrenic patients, who were followed prospectively for up to four years. In a second part of the study, a subgroup of the patients were interviewed using the Life Event and Difficulty Schedule 9 months after discharge or at relapse. Patients contented with low social integration had a higher relapse rate over four years than patients lacking of social provisions, but wanting more. We found an excess of life events three weeks before relapse compared to events reported in the non-relapsing group. Suggesting a buffering effect of social factors, time between life event and relapse was significantly extended among patients with a high availability of attachment and a coping strategy characterised of active support seeking.

Adaptation, Psychological↗
PubMed1997

Factors predicting fractures during falling impacts among home-dwelling older adults.

OBJECTIVE: To investigate the predictors of fractures during falling impacts among home-dwelling older adults. DESIGN: A case-control study within a prospective, population-based survey. SETTING: Five rural municipalities in northern Finland. PARTICIPANTS: The study population consisted of all home-dwelling persons aged 70 or older living in these five municipalities (n = 790 (85%)). The cases for this study were those with fracture, using the first fracture (n = 82) in the analyses, during a follow-up period of 4 years. Controls (n = 82) were selected from among the persons who suffered soft tissue injuries; matching was by age, sex, and location of the first injury during the period. MEASUREMENTS: During a 4-year follow-up period, all falls in the population were recorded using fall diaries, telephone interviews, and information from medical records. Risk factors for fractures during the 4-year follow-up were determined according to the number and severity of previous falls, circumstances and place of falls, disease history, use of medicines, symptoms, clinical examinations and tests, nutritional status, functional abilities and social and health behavior. Cross-tabulations for categorial variables, paired t tests for the means of continuous variables, and conditional logistic regression analysis were performed. RESULTS: According to the bivariate analyses, the risk factors for falls resulting in a fracture were frequent fear of falling, abnormal heel-shin test, reduced knee extension strength, reduced grip strength, poor distance visual acuity, low supine pulse rate, inability to carry a 5-kg load 100 meters, not doing heavy outdoor work, and no habitual exercise. A limited amount of social participation was associated negatively with fracturing. Conditional logistic regression analysis showed that the risk factors for fracture-causing falls were frequent fear of falling (OR 2.50; CI 1.11-5.65), reduced knee extension strength (OR 3.38; CI 1.00-11.4), and poor distance visual acuity (OR 3.45; CI 1.13-10.6), whereas limited social participation (OR 0.29; CI 0.11-0.79) protected against the occurrence of fractures. CONCLUSION: Impaired perception, muscle strength, and psychological and social functioning may influence fracture risk during injurious fall impacts. Studies with larger sample sizes are needed to confirm this and to examine the circumstances and mechanisms contributing to the fracture risk during falls via these risk factors.

Accidental Falls↗
PubMed1991

Imaginary audience behavior in older adolescent females.

The purpose of this study was to explore the extent of imaginary audience behavior in older adolescent females to ascertain if such behavior continues beyond the years of early and middle adolescence. Subjects were 112 freshman females enrolled in a midwestern university during their first semester. Results indicated that college freshman displayed a greater degree of imaginary audience behavior than did younger adolescents when compared to scores reported by Elkind and Bowen (1979). Findings support the view that later adolescents' entry into new social environments results in greater protection of the self, a return to previous behaviors, and an increase in egocentrism as evidence in less willingness to reveal oneself to an audience.

Adaptation, Psychological↗
PubMed2000

Domestic AIDS vaccine trials: addressing the potential for social harm to the subjects of human experiments.

In 1998, the FDA approved the first large-scale human trials of a candidate AIDS vaccine in our nation's history. While the legal issues raised by these trials are manifold, the academic literature has focused almost exclusively on the potential for mass tort liability and the resulting hesitancy of biotech and pharmaceutical firms to enter the field. This Comment argues that another issue of vital concern demands attention: the potential for social harm to the human subjects of AIDS vaccine trials. After providing an overview of the current epidemiology of HIV/AIDS and explaining why a safe, effective AIDS vaccine represents the best way to control the pandemic, this Comment analyzes the scientific and social obstacles to production of such a vaccine. In order to know whether a candidate AIDS vaccine is truly effective, researchers will have to test the product in HIV-negative volunteers at high risk of infection. Since these volunteers may subsequently test positive for HIV on standard blood tests, they will be vulnerable to discrimination on that basis in such areas as employment, insurance, immigration, and incarceration. Moreover, by participating in vaccine trials, volunteers will be marking themselves as people at high risk of HIV infection, another basis for disparate treatment. Researchers have suggested that federal disability discrimination law may afford protection against research-related social harms. Through close analysis of the Americans with Disabilities Act of 1990 and the Supreme Court's decision in Bragdon v. Abbott, this Comment demonstrates that optimistic reliance on federal disability law is misplaced. The unique issues raised by domestic AIDS vaccine trials must be addressed in their own right. The Comment accordingly concludes with a broad range of legislative and regulatory proposals to protect trial participants and advance the AIDS vaccine research agenda.

Animals↗
PubMed1996

Protective and risk predictors in the development of drug use.

The authors examined the relationship of two dimensions of the theory of social development--vulnerability (predictors, risk factors) and protectivity--in two samples, schoolchildren aged ten to fifteen years and addictive drug users. On the basis of the Hirschi model of protective factors, they found that the most important protective factors (attachment, commitment, involvement, belief) act against substance use. A surprising finding was that among the predictors of the addicts some forms of escape from the family act against the development of drug use, that is, they can be regarded as a protective predictor. The findings of the study draw attention to the complexity of the vulnerability-protectivity relationship and to the need for further research.

Adolescent↗
PubMed1991

Gender roles, social support, and postpartum depressive symptomatology. The benefits of caring.

Although women are assumed to be particularly vulnerable to depressive symptomatology after childbirth, the extent to which this symptomatology predominates over that found in men at this life cycle stage has not been addressed. This study examined gender differences in postpartum depressive symptomatology and the link between postpartum symptomatology and gender roles and relationships in a sample obtained from childbirth preparation classes. The data show no gender difference in depressive symptomatology at 2 months after childbirth. Women manifested a decrease in depressive symptomatology and men showed a slight increase from the preparenthood point. We partially link women's equivalent rather than higher distress levels to the protective effects of their varied social supports. By contrast, men depended primarily on their spouses, but both genders experienced a decrease in spouse support after childbirth. Female lack of support was more strongly associated with symptomatology in homemakers compared with employed women or women on maternity leave. Within the context of gender role changes, the data highlight benefits of female bonding in contrast to the "costs of caring" depicted by other researchers.

Adult↗
PubMed2006

The development of wild immature Sumatran orangutans (Pongo abelii) at Ketambe.

Orangutans have the longest immature period and inter-birth interval of all ape species. This may be explained by a slow life history, the need to develop skills or by their relatively solitary lifestyle, which prevents a mother from associating with two offspring. This study of wild immature orangutans at the Ketambe Research Station, Indonesia, describes, with partly cross-sectional, partly longitudinal data, their development to independence. The study subjects ranged from 1 to 11 years of age. Data on their activity budget, diet, mother-offspring proximity and maintenance of proximity, association with conspecifics and play behavior were collected. The results indicate that immature orangutans can provide for their own food and transport, and therefore were independent of direct maternal care, at an age of possibly 3 but more clearly 6 years. This is similar to chimpanzees, and refutes the slow life history hypothesis. Immature orangutans remain within their mother's vicinity until the age of 8 years, indicating a dependence on indirect maternal care, and this coincides with the period during which the mother does not produce another offspring. A female orangutan seems unable to associate with an older immature while caring for a new infant. This is consistent with the solitary-lifestyle hypothesis and corroborates the results obtained with the Sumatran orangutan population at Suaq Balimbing. However, why an immature depends indirectly on its mother for such a long period remains unclear. It is possible that it needs to develop ecological or social skills or needs the protection of its mother. Unfortunately, no data were available to distinguish between these possibilities.

Age Factors↗
PubMed2006

Individual characteristics are less important than event characteristics in predicting protected and unprotected anal intercourse among homosexual and bisexual men in Melbourne, Australia.

OBJECTIVE: To describe individual, social network and encounter specific factors associated with protected anal intercourse (PAI) and unprotected anal intercourse (UAI). METHODS: This was a cross sectional survey conducted between April and November 2002. A total of 733 sexual encounters were reported by 202 men recruited from the gay community in Melbourne, Australia. Predictors of self reported PAI and UAI were examined. RESULTS: Of the 733 sexual events most (56.3%) did not involve anal intercourse, and more involved PAI than UAI (30.6% versus 13.1%). PAI was more likely than no anal intercourse (NAI) if the participant's social network was mostly homosexual, the partner was an occasional or casual partner, or was HIV positive. PAI was less likely if sex took place at a "beat" but more likely if it took place at a sauna. PAI was more likely if the partner was affected by drugs or alcohol. UAI was more likely than NAI if the participant had injected drugs in the year before interview. It was less likely if the partner was occasional or casual or was HIV positive but more likely if the partner's HIV status was unknown. UAI was much more likely than NAI if the encounter took place at a "sex on premises" venue. CONCLUSIONS: In this analysis it is the characteristics of the sexual encounter that predict whether PAI or UAI rather than NAI takes place.

Adolescent↗
PubMed1990

Causes of fatal childhood accidents involving head injury in northern region, 1979-86.

OBJECTIVE: To examine the causes and circumstances surrounding fatal accidents involving head injuries in children in the Northern region. DESIGN: Retrospective review of the hospital case notes, necropsy reports, and records of the coroners' inquests. SETTING: Northern Regional Health Authority. PATIENTS: All 255 children aged less than 16 years who died with a head injury during 1979-86. MAIN OUTCOME MEASURES: Cause of injury and circumstances of accident according to reports of inquests; injury severity score; number of fatal accidents and mortality per 100,000 children in 10 groups of local authority wards ranked according to their score on the overall deprivation index; and distance of site of accident from child's home. RESULTS: Of the 255 children who died after a head injury, 136 (53%) children were playing at the time of the accident. 195 (76%) children sustained the head injury in road traffic accidents, 135 as pedestrians, 35 as cyclists, and 25 as passengers in a vehicle. In 120 accidents in child pedestrians the primary cause of accident was the unsafe behaviour of the child. 172 (67%) accidents occurred within one to two km of the child's home and 153 (63%) between 3 pm and 9 pm. The mortality was significantly related to social deprivation; excluding eight children injured while on holiday in the region, 15-fold decrease in mortality was recorded between the local authority wards that ranked highest on the overall deprivation index and those that ranked lowest (14.0/100,000 children, group 10 v 0.9/100,000, group 1 respectively, p less than 0.00001). CONCLUSIONS: The finding that most accidents occurred in children living in deprived areas who were playing unsupervised near their home suggests that childhood mortality might be appreciably reduced if children at play were protected from traffic, particularly in socially deprived areas.

Accidental Falls↗