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PubMed1985

Unanticipated problems in the United States child protection system.

While the United States child protection system is widely recognized as probably the most sophisticated and wide-ranging in the world, it nevertheless has some inherent problems. This article addresses some of the negative effects of mandatory reporting and the lack of fit of a short-term crisis intervention treatment approach for a substantial proportion of the protective services population. Reporting may have detrimental effects on the client-reporter relationship. Further, over half of the cases investigated are not substantiated. Of concern are the impact on innocent families of being investigated and the waste of scarce worker resources on investigation. While some protective services families are well suited to a crisis intervention model, a large number are multiproblem families who are always in crisis and families with chronic problems for whom crisis intervention is totally inadequate. Furthermore, because of high caseload size, workers are often not available to intervene after they have investigated the case. The problems described have been exacerbated by funding cutbacks under the current United States administration. The child protection system, along with other social welfare programs, is at risk for being dismantled by the Reagan administration.

Child↗
PubMed2005

Physical stature of adult Tsimane' Amerindians, Bolivian Amazon in the 20th century.

We examine the association between exposure to the market and Western society on the height of adult Tsimane', a foraging-farming society in the Bolivian Amazon. As with other contemporary native peoples, we find little evidence of a significant secular change in height during 1920-1980. Female height bore a positive association with own schooling and fluency in spoken Spanish and with maternal modern human capital (schooling, writing ability, and fluency in spoken Spanish), but male heights bore no association with parental height or with modern human capital. The absence of a secular change likely reflects the persistence of traditional forms of social organization and production that protect health.

Adult↗
PubMed1998

Responses of slaughter pigs to transport and lairage sounds.

The behavioral and physiological responses of pigs to transport and subsequent exposure to slaughterhouse sounds were examined. Forty-one groups of four slaughter pigs were separately loaded onto a lorry and transported for 25 min. Another 43 groups were loaded onto the lorry which then remained stationary for 25 min. Following unloading pigs were moved to a race with a length of 15 m and a width of 1.5 m. Either one of the following sounds was played at 85 dB(A) for 10 min: Pigs in front of the restrainer, Machines in lairage, White Noise, or Control (no sound). Pigs exposed to the Machines and White Noise treatment spent significantly more time close to their group-mates compared with Control pigs, with pigs subjected to the Pig sound being intermediate. Transported pigs spent less time exploring the race and were less active than pigs from the stationary lorry. Heart rate was higher during transport than during the stationary period. In contrast, during unloading, the sound exposure period and the post-sound period, heart rate was lower in the transported groups. Heart rate did not significantly differ between sound treatments. Salivary cortisol concentrations were significantly higher after transport than after the stationary period and remained higher for transported pigs after the sound exposure period. Cortisol levels did not differ significantly between sound treatments. It is tentatively suggested that social support from conspecifics may protect pigs from potentially adverse effects of exposure to lairage sounds.

Abattoirs↗
PubMed2002

The world report on violence and health.

In 1996, the World Health Assembly declared violence a major public health issue. To follow up on this resolution, on Oct 3 this year, WHO released the first World Report on Violence and Health. The report analyses different types of violence including child abuse and neglect, youth violence, intimate partner violence, sexual violence, elder abuse, self-directed violence, and collective violence. For all these types of violence, the report explores the magnitude of the health and social effects, the risk and protective factors, and the types of prevention efforts that have been initiated. The launch of the report will be followed by a 1-year Global Campaign on Violence Prevention, focusing on implementation of the recommendations. This article summarises some of the main points of the world report.

Global Health↗
PubMed1997

Disclosure practices and cultural narratives: understanding concealment and silence around cancer in Tuscany, Italy.

Disclosure practices are embedded in and enact personal, professional, and societal narratives. These narratives are not given but contested and evolving. The medical arena constitutes an important social space in which this contestation, reproduction and change take place. More specifically, based on ethnographic and cultural survey data, we describe and interpret the cultural sense of "not telling" about cancer within the local world of Tuscany, Italy. We locate the traditional practice of non-disclosure of cancer diagnoses within a larger cultural narrative we call "social-embeddeness", a narrative of social unity and hierarchy, of protection from or adaptation to the inevitable necessities of life, in part by using narrative itself to construct a sense of group protection. This narrative is being challenged, as it confronts other medical and societal narratives, such as one originating from the United States and embedded in health care practices like open disclosure, informed consent, Advanced Directives, and the Patient Self-Determination Act, what we call the "autonomy-control narrative". Explicit disclosure to a patient about his or her illness and the future plays an important role in actualizing this narrative, in helping in the quest to control one's destiny, eliminate uncertainty and necessity, and foster a person's identity as singular and sovereign over him/herself. The concept "narrative" highlights the ideology and intent of people's practices, not just "outcome", and helps us understand contradictions in various disclosure contexts as partly due to multiple cultural narratives in play. Considering some of the practices and understandings embedded within and reproduced by the larger cultural narratives also allows us to track the dynamics of history and individual biography, to locate and compare approaches to disclosure across time and space, and to avoid the pitfalls of cultural determinism and cultural stereotypes.

Bioethics↗
PubMed2002

Psychosocial work characteristics as risk factors for the onset of fatigue and psychological distress: prospective results from the Maastricht Cohort Study.

BACKGROUND: Prolonged fatigue has recently attracted attention in occupational (mental) health research since it may lead to sickness absenteeism and work disability. To date, little is known about the role of psychosocial work characteristics in the aetiology of fatigue. In this study we examined prospectively a wide range of psychosocial work characteristics as possible risk factors for the onset of fatigue and psychological distress in the working population. METHODS: This study is based on 8833 employees, participating in the Maastricht Cohort Study of 'Fatigue at Work'. A wide range of psychosocial work characteristics, measured at baseline, was used to predict the onset of fatigue and psychological distress 1 year later. Fatigue was measured with the Checklist Individual Strength; the General Health Questionnaire was used to measure psychological distress. RESULTS: The cumulative incidence of fatigue during 1 year follow-up was 9.7% (N = 492) in men, and 13.5% (N = 241) in women. Psychological demands at work as well as physical and emotional demands increased the risk for fatigue in men, whereas decision latitude in men and co-worker social support in women were protective against fatigue. These prospective associations remained significant after adjustments for potential confounders and baseline fatigue. As regards psychological distress, no association was found with decision latitude, while conflicts at work increased the risk of psychological distress. CONCLUSIONS: Psychosocial work characteristics were significant predictors for the onset of fatigue in the working population. The prospective associations suggest some differential effects in the aetiology of fatigue and psychological distress. Good interpersonal relationships at work and high decision authority were demonstrated to be relevant aspects that should be targeted for prevention.

Adolescent↗
PubMed2004

Studying the dynamics of problem behavior across multiple time scales: prospects and challenges.

As a commentary on the Special Issue, this paper discusses recent advances in the study of change across several time scales. It points out the importance of specifying time scales and putative patterns of change when characterizing problem behavior over developmental time scales. Methods for studying risk and protective mechanisms through observation of social interaction are also discussed as a way to study influences that operate in real time. Methods for studying episode-level interaction patterns that result from such real-time influences are also discussed, along with ways to integrate these with longitudinal assessments to study the effects of social interaction on problem behavior across developmental time scales.

Behavioral Research↗
PubMed1996

Caregivers' appraisals of efficacy in coping with dementia.

This study investigated the types, prevalence, and stability of appraisals of coping efficacy made by 87 family caregivers of persons with dementia. With the use of content analysis, 12 efficacy appraisals were identified that reflected caregivers' perceptions of progress in problem-solving, regulating emotional distress, protecting self-esteem, managing social interactions, and self-development. Most appraisal types showed variability across 2 time points, which suggests that appraisals reflect changing person-environment transactions. Five of the appraisals-namely, nonefficacious coping outcomes, no coping options, no control, an improved ability to cope, and means/ends insights-were prospectively related to distress and well-being. The findings suggest that a broad set of goals guides coping efforts in the context of chronic stress.

Adaptation, Psychological↗
PubMed2003

Vulnerable adolescent mothers' perceptions of maternal role and HIV risk.

Pregnant adolescents and young mothers living in Los Angeles County are vulnerable to acquiring HIV/AIDS through sexual transmission because they lack the resources, social status, and power to protect themselves. In this article we describe adolescent mothers' (n = 76) responses to an HIV prevention program. The design of the study was based in ethnography, the anthropological tradition of qualitative research. Many of the pregnant teens and young mothers described how the experience of becoming a mother helped empower them to improve their lives. Yet efforts to decrease risky sexual behavior were overshadowed by more immediate concerns and by relationship issues of gender and power and of trust.

Adolescent↗
PubMed2000

Controversial attachments: the indirect treatment of fostered and adopted children via Parent Co-Therapy.

Fostered and adopted children often show a large array of psychosocial problems and are conceptualized as having attachment disorders. It can be necessary to engage such children in direct mental health treatment, in addition to interventions set up to deal with their problems through agencies such as Education and Social Services. In order to protect children from a multitude of treating professionals, thereby potentially further weakening the emerging parental attachments, a model is proposed of indirect treatment of children, with the adoptive parents as co-therapists. This elevates the status of parents and is controversial in child mental health work as it challenges traditional hierarchies. We refer to this model, based on a single case study, as Parent Co-Therapy (PCT). It is proposed that this may be a suitable treatment model for fostered and adopted children, particularly in the early years of placement. The model has the potential to strengthen the children's attachments to the parents and vice versa, with a concomitant reduction in symptomatology.

Adoption↗
PubMed2006

Financing mental health services in low- and middle-income countries.

Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

Developing Countries↗
PubMed2000

Early psychological reactions to life-threatening injuries.

OBJECTIVE: To assess the prevalence of posttraumatic stress symptoms and coping patterns in severely injured accident victims; to study correlations between injury severity and psychosocial variables and the presence of posttraumatic stress symptoms; and to analyze intensive care unit (ICU) personnel's global clinical appraisals in relation to patient characteristics. DESIGN: A study of critically ill accident victims assessed within one month of the trauma. SETTING: ICU of the traumatology department at the University Hospital, Zurich. PATIENTS: 121 consecutive patients with accidental injuries (mean Injury Severity Score, 21.8; mean Glasgow Coma Scale score, 14.4) admitted to the ICU between January 1996 and June 1997, aged 18-68 yrs. Patients with severe head injuries, attempted suicides, and victims of physical assault were excluded. MEASUREMENTS: Extensive clinical interview, Impact of Event Scale, Clinician-Administered Posttraumatic Stress Disorder Scale, social support, life events, biographical protective and risk factors, Sense of Coherence questionnaire, Freiburg Questionnaire of Coping with Illness. RESULTS: 13.7 (SD, 6.8) days after the accident, 5 patients (4.1 %) met all criteria for posttraumatic stress disorder with the exception of the time criterion. A further 24 patients (19.9%) had subsyndromal posttraumatic stress disorder. Posttraumatic psychiatric symptomatology did not correlate with objective injury criteria, but rather with pretrauma variables (female gender, biographical risk and protective factors, life events), the patients' subjective appraisal of the severity and threat of the accident, their general attitude toward life ("sense of coherence"), and their current coping strategies. Surgeons' and nurses' global clinical appraisals did not correlate with injury severity or with the patients' coping strategies. CONCLUSIONS: Trauma surgeons and ICU personnel should pay special attention to the strains and stressors their patients have been exposed to when recording case histories and to the level of their patients' psychosocial adaptation before the trauma.

Adaptation, Psychological↗
PubMed1997

Ethical issues in radiation protection.

In this note the authors survey existing international radiation-protection recommendations of the ICRP, the IAEA, and the ILO. After outlining previous work on the ethics of radiation protection and risk assessment/management, the authors review ethical thinking on five key issues related to radiation protection and ethics. They formulate each of these five issues in terms of alternative ethical stances: (1) Equity vs. Efficiency, (2) Health vs. Economics, (3) Individual Rights vs. Societal Benefits, (4) Due Process vs. Necessary Sacrifice, and (5) Stakeholder Consent vs. Management Decisions.

Compensation and Redress↗
PubMed2006

Development of a music group psychotherapy intervention for the primary prevention of adjustment difficulties in Korean adolescent girls.

PROBLEM: Traditionally, adolescent mental health in Korea has not been a prime focus for educators, health workers, and politicians, yet a majority of sampled adolescents report interpersonal sensitivity (Kim, 2003). METHOD: Thirty-five adolescent girls took part in a six-session school-based music group psychotherapy pilot intervention designed to promote relationships and improve self-control skills. FINDING: Participants identified several outcome benefits that may serve as protective factors in their continued social and emotional development. CONCLUSIONS: Music is a medium that promotes interpersonal relatedness among Korean adolescent girls. More research is necessary to identify long-term benefits of preventive music group psychotherapy interventions among the adolescent population.

Adjustment Disorders↗
PubMed2000

Advances in Plant Health Management in the Twentieth Century.

▪ Abstract Plant health management is the science and practice of understanding and overcoming the succession of biotic and abiotic factors that limit plants from achieving their full genetic potential as crops, ornamentals, timber trees, or other uses. Although practiced as long as agriculture itself, as a science-based concept, plant heath management is even younger than integrated pest management (IPM), and includes and builds upon but is not a replacement for IPM. Probably the greatest collection of success stories for plant health management is the number of diseases managed by cleaning up the planting material. The record for root health management is more mixed, with the loss or phase-out of soil fumigants, and practices such as crop rotation and clean tillage being replaced with more intensive cropping and less or no tillage. Perhaps the greatest scientific and technical advances for plant health management have come from the work aimed at management of the pathogens, pests, and other hazards that arrive by air. Flor's work on flax rust, which produced the gene-for-gene model, is possibly the most significant contribution of plant pathology to the life sciences in the twentieth century. Research aimed at the management of foliar pathogens is also the basis for modern theory on epidemiology, population biology, aerobiology, and disease prediction and decision-support systems. Even IPM arose mainly in response to the need to protect crops from pests that arrive by air. If the definition of biological control includes the plant induced or genetically modified to defend itself, as it should, then biological control has been the most significant approach to plant health management during the twentieth century and promises through modern biotechnology to be even more significant in the twenty-first century. Rather than "reducing losses," the advances are discussed here within the simple framework of achieving the attainable yield by increasing the actual and/or affordable and hence the average yield. Each of these four benchmark yields, as well as the absolute yield for crops, and their significance to the goals and achievements of plant health management are defined. Plant health management is a moving target, which I discuss metaphorically like an American football game, where one team is science and technology and the other is nature, where the S & T team is only beginning to know nature's rules while playing itself with the three sets of rules written to, respectively, satisfy the laws of economics, protect the environment, and gain social acceptance.

Journal Article↗
PubMed2005

The death of managed care: a regulatory autopsy.

On the heels of widespread patient protection legislation in the states, the managed care industry abandoned or greatly scaled back the core elements of gate-keeping, utilization management, and financial incentives, which are the very targets of this legislation. This article explores whether, and to what extent, the industry's abrupt change in course can be attributed to these laws. Based on extensive interviews with key informants in six representative states, the article concludes that these laws were not the primary driver of changes in managed care practices. However, patient protection laws interacted with other social and market forces, through complex forms of feedback and reinforcement, to bring about more thoroughgoing change than would have otherwise occurred.

Gatekeeping↗
PubMed2000

Substance abuse and parenthood: biological mechanisms--bioethical challenges.

This review catalogues the long-term health effects of parental recreational drug abuse on the fetus and the subsequent well-being of the child. It is hard to conceive that parents would knowingly harm the health of their children, yet toxic effects resulting from ignorance, addiction or any of a number of socioeconomic factors are still responsible for handicapping countless potentially healthy offspring. The negative effects of female recreational drug and alcohol abuse during pregnancy are well documented, but exposure prior to conception and male-mediated effects are less well publicized. Abnormalities in the sperm are prevalent among men who consume recreational drugs, and birth defects are more often linked with paternal than with maternal DNA damage. This review is divided into three parts. Part I describes the biology and potential mechanisms of adverse alterations in reproductive potential, Part II explores the socioeconomic determinants of substance use, and raises the question of poverty. Drug-induced disability is not evenly distributed among the population as there are ethnic and socioeconomic disparities of infant mortality, childhood morbidity and reproductive dysfunction. Part III describes the author's conclusion that fundamental social change is needed to protect future children without threatening parents' basic freedom, and real change requires new beliefs and prioritics that must evolve from the ground up. An ecological model of care concentrating on health issues is described. Such an ecological model of care is in tune with the fundamental principles of bioscience ethics and emphasises that high quality education, health and good preconceptional/prenatal care are essentials in the search for greater equity in standard of living across a population.

Abnormalities, Drug-Induced↗
PubMed2002

Re-traumatization among adult women sexually abused in childhood: exploratory analyses in a prospective study.

The current exploratory study examined a variety of risk factors related to re-traumatization, defined broadly, in a prospective sample of women who were sexually abused in childhood. Eighty women, who were part of a larger longitudinal study of the effects of child sexual abuse, were interviewed at three points in time: in childhood and at two points in early adulthood. Risk factors were measured at the second interview and used to predict reported trauma exposure between interviews two and three. Given theoretical arguments for differences in risk factors based on ecological context, analyses were conducted separately for married and unmarried women. Situational and intrapersonal risk factors such as homelessness and depression were predictive of re-traumatization risk while reported social support satisfaction was a protective factor. Reports of trauma exposure between interviews two and three were related to mental health symptoms.

Adolescent↗