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PubMed1996

Innovative models for rural child protection teams.

This paper describes child protection teams in rural Newfoundland and Labrador, Canada. The teams have developed an innovative model that encourages a community-based response to child abuse. Child protection teams usually follow the case consultation model, which is a group of professionals dealing with specific cases of child abuse. In Newfoundland and Labrador, child protection teams evolved away from this type of approach. Communities in the province face unique social and economic conditions and as a result child protection teams now mainly focus on prevention through public education and awareness, advocacy, and professional development. Many of the child protection teams have developed a two-tiered model. The first tier of the team includes community representatives who participate in the activities listed above. The second tier is involved with case conferences and is composed only of professionals dealing directly with the cases of child abuse. This paper discusses the child protection team model emerging in Newfoundland and Labrador in contrast to those described in the literature.

Child↗
PubMedDate not supplied

Ocular risks from sunlight exposure.

Relinquishing the desire to acquire a tan will be difficult for many people. To many individuals, a tan is a symbol of health, fashion and attractiveness. Even when informed about the risks of sunlight exposure, many people ignore the advice to change their behaviors and decrease their risks. Adoption of safe sunlight precautions depends on individual preference, age, work requirements, gender, and perception of personal risk. Many people selectively adhere to certain protective behaviors which do not conflict with social norms. Reinforcement of how sunlight can damage the eyes and skin needs to be continually provided so that public attitudes can adapt to all the necessary appropriate behaviors. Ophthalmic health care professionals have an important part in public education. They can customize their patient's personal protective requirements to match the type of risks uncovered in the clinical work up. The ocular and social history should include the patient's sunlight exposure risk profile and document pre-existing sunlight damage to the eyes and facial areas. All follow-up visits should reinforce sunlight exposure information and document compliance or non-compliance. Only in this way can the eye care delivery system support preventative measures to decrease ocular injuries from sunlight radiation.

Environmental Exposure↗
PubMed2002

Are the performance overestimates given by boys with ADHD self-protective?

Tested the self-protective hypothesis that boys with attention deficit hyperactivity disorder (ADHD) overestimate their performance to protect a positive self-image. We examined the impact of performance feedback on the social and academic performance self-perceptions of 45 boys with and 43 boys without ADHD ages 7 to 12. Consistent with the self-protective hypothesis, positive feedback led to increases in social performance estimates in boys without ADHD but to decreases in estimates given by boys with ADHD. This suggests that boys with ADHD can give more realistic self-appraisals when their self-image has been bolstered. In addition, social performance estimates in boys with ADHD were correlated with measures of self-esteem and positive presentation bias. In contrast, for academic performance estimates, boys in both groups increased their performance estimates after receiving positive versus average or no feedback, and estimates were not correlated with self-esteem or social desirability for boys with ADHD. We conclude that the self-protective hypothesis can account for social performance overestimations given by boys with ADHD but that other factors may better account for their academic performance overestimates.

Achievement↗
PubMed2005

Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample.

BACKGROUND: Epidemiological studies have found lower than expected prevalence of psychiatric disorders among disadvantaged race-ethnic minority groups in the USA. Recent research shows that this is due entirely to reduced lifetime risk of disorders, as opposed to persistence. Specification of race-ethnic differences with respect to clinical and social characteristics can help identify the protective factors that lead to lower lifetime risk among disadvantaged minority groups. METHOD: Data on 5424 Hispanics, non-Hispanic Blacks, and non-Hispanic Whites came from the National Comorbidity Survey Replication, a nationally representative survey conducted with the World Mental Health version of the Composite International Diagnostic Interview. Race-ethnic differences in risk of disorders were compared across specific diagnoses, ages of onset, cohorts and levels of education. RESULTS: Both minority groups had lower risk for common internalizing disorders: depression, generalized anxiety disorder, and social phobia. In addition, Hispanics had lower risk for dysthymia, oppositional-defiant disorder and attention deficit hyperactivity disorder; non-Hispanic Blacks had lower risk for panic disorder, substance use disorders and early-onset impulse control disorders. Lower risk among Hispanics, relative to non-Hispanic Whites, was found only among the younger cohort (age<or=43 years). Lower risk among minorities was more pronounced at lower levels of education. CONCLUSION: The pattern of race-ethnic differences in risk for psychiatric disorders suggests the presence of protective factors that originate in childhood and have generalized effects on internalizing disorders. For Hispanics, but not for non-Hispanic Blacks, the influence of these protective factors has emerged only recently.

Adolescent↗
PubMed2000

Child abuse and unintentional injuries: a 10-year retrospective.

OBJECTIVE: To identify differences between hospitalized children injured by child abuse and those with unintentional injuries. DESIGN: Comparative analysis of patients injured by child abuse (n = 1997) with patients injured unintentionally (n = 16 831), newborn to 4 years of age. MAIN OUTCOME MEASURES: Patient characteristics, nature and severity of injury, treatment, length of stay, survival, functional limitations, and disposition at discharge from the hospital. DATA SOURCE: Retrospective review of medical records submitted to the National Pediatric Trauma Registry between January 1, 1988, and December 31, 1997. RESULTS: During the 10-year study period, child abuse accounted for 10.6% of all blunt trauma to patients younger than 5 years. Children injured by child abuse were significantly younger (mean, 12.8 vs 25.5 months) and were more likely to have preinjury medical history (53% vs 14.1%) and retinal hemorrhages (27.8% vs 0.06%) than children with unintentional injuries. Abused children were mainly injured by battering (53%) and by shaking (10.3%); unintentionally injured children were hurt mainly by falls (58.4%) and by motor vehicle-related events (37.1%). Abused children were more likely than unintentionally injured children to sustain intracranial injury (42.2% vs 14.1%) and thoracic (12.5% vs 4.5%) and abdominal (11.4% vs 6.8%) injuries; to sustain very severe injuries (22.6% vs 6.3%); to be admitted to the intensive care unit (42.5% vs 26.9%); and to receive Child Protective Services (82.3% vs 8%) and Social Services (72.9% vs 27.6%) intervention. The mean length of stay for children who were abused was significantly longer (9.3 vs 3.8 days) and the survival to discharge from the hospital was significantly worse (87.3% vs 97.4%) than for those unintentionally injured. Among the survivors, children who were abused developed extensive functional limitations more frequently than those unintentionally injured (8.7% vs 2.7%). More than half (56.6%) of the children who were abused were discharged to custodial/foster/Child Protective Services care; most (96.1%) of the children unintentionally injured returned to their homes. CONCLUSIONS: Child abuse continues to be a serious cause of mortality and morbidity to infants and toddlers. On average, among children hospitalized for blunt trauma, those injured by abuse sustain more severe injuries, use more medical services, and have worse survival and functional outcome than children with unintentional injuries.

Case-Control Studies↗
PubMed1995

[Theory and practice in rehabilitation of emotionally handicapped young patients].

Since January 1995 the new German Social Aid and Child Care and Protection Legislation (KJHG, Kinder-und Jugendhilfegesetz) is applied in all parts of Germany (Federal Legislation), for children and adolescents with psychiatric disturbances and special support system is created. These children have the right to get different sorts of help for their integration in school, in the peer-group, and in the society. The fact, that a child and adolescent psychiatric diagnosis is necessary to get these different kinds of help, has been criticized. Especially social-workers fear the negative effects of a so-called psychiatric "labeling". More information and cooperation between child psychiatrists and social-workers is necessary with regard to the new legislation. We analysed different measures (N = 1329) supported by this new legislation in our recourse population in 1992 and 1993. Effects of age, sex and socioeconomic status on the indication of psychotherapy within the health care-system or within the new (KJHG) legislation system are described. The follow-up part of the study reports results of these new forms of help for children in 140 of pour patients. We found more symptom reductions in the former diagnosed psychiatric disturbances than an improvement in the psychosocial and family life conditions of the children.

Adolescent↗
PubMed1990

The Baby Doe regulations: views from perinatal social workers.

In 1984 the federal government issued the "Baby Doe" regulations, designed to protect the rights of handicapped infants. Members of the National Association of Perinatal Social Workers were asked to evaluate these regulations and were given the opportunity to comment on their impact. The authors present and discuss these comments with respect to the helpfulness of the regulations, physician discretion, parental rights, and the social work role.

Child Abuse↗
PubMed2002

Ready to die: a postmodern interpretation of the increase of African-American adolescent male suicide.

African-Americans have typically registered lower rates of suicide than other ethnic groups. In the last 20 years this pattern has changed, particularly among young African-Americans between the ages of 15 and 19 (National Center for Injury Prevention and Control, Mortality Statistics, 1998, Atlanta, GA). Today, young African-American males are as likely to commit suicide as their White counterparts. To date, the research conducted regarding this phenomenon has been inconclusive and existing suicide interventions appear to have no effect on reducing this behavior among young African-Americans. This paper synthesizes classical (Durkheim, Suicide, 1979, Free Press, New York) and postmodern (Beck, Risk Society: Towards a New Modernity, 1992, Sage, London; Bauman, Modernity and Ambivalence, Cornell University Press, Ithaca, 1991) social theories in order to provide a more complete theoretical explanation for the increase in the suicide rate among adolescent African-American males. Postmodern society is typified by: (1) institutional deconstruction; (2) decreased collectivism; (3) increased normlessness and helplessness; and (4) exacerbated personal risk for stress. It is therefore possible to hypothesize that postmodernity characteristically loosens the bonds between the individual and society, thereby increasing vulnerability to depression, related pathologies (such as substance abuse), and suicide. African-Americans tend to be more affected/vulnerable because they are concentrated in resource-poor, low income areas, and institutions that provided social support (family, religious, community) and protected individuals from societal risk factors, have gradually been dissolving in postmodern societies. We argue that young African-American males of today are more exposed to stressors which increase psychological distress thus increasing depression and related pathological behaviors such as suicide. The main reason behind this increase is found in the inability of institutions to offer protection from psychological distress. Overall, this paper presents a postmodern, macro-level framework to explain the increase in suicide among African-American male adolescents.

Adolescent↗
PubMed2005

Getting the mix right: family, community and social policy interventions to improve outcomes for young people at risk of substance misuse.

Societal responses to the existence of substance misuse fluctuate between harm minimisation and prohibition. Both approaches are predominantly downstream reactions to substance misuse that focus on the supply of harmful substances and the containment of misuse through treatment, rehabilitation or punishment. Until recently, little attention has been paid to the upstream individual, family, relationship, community or societal antecedents of substance misuse (which often overlap with those for other adverse life outcomes, such as unemployment, antisocial personality disorder and mental health problems) that have operated during earlier life. A growing body of evidence highlights the overlapping biological and experiential antecedents for substance abuse and other poor outcomes as well as the trajectory-changing protective factors that can prevent risks being translated into destiny. Risk minimisation and protection enhancement embedded in family and social systems are the essential building blocks of a set of early intervention strategies that begin antenatally and continue through the developing years of childhood, adolescence and young adult life, that have been shown to be effective in improving many outcomes in development, health and well-being. Much remains to be done to enable the promise of effective universal and targeted early intervention to be translated into policies, programs and practices that could be life-changing for citizens bogged in the mire of substance misuse and their children. Realistic, timely investment, influenced by the best scientific evidence indicating what works, for whom, under what circumstances, an increased degree of collaboration within and between governments and their agencies to enable "whole of government" responses in partnership with community-based initiatives are essential along with investments in multidisciplinary program evaluation research that will enable evidence-informed policy decisions to be tailored to the needs of individual countries.

Adolescent↗
PubMed1999

Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study.

OBJECTIVES: The impact of work on the risk of future psychiatric disorder has been examined in few longitudinal studies. This was examined prospectively in a large epidemiological study of civil servants. METHODS: In the Whitehall II study, a longitudinal, prospective cohort study of 6895 male and 3413 female London based civil servants, work characteristics measured at baseline (phase 1: 1985-8) and first follow up (phase 2: 1989) were used to predict psychiatric disorder measured by a 30 item general health questionnaire (GHQ) at phase 2 and phase 3 follow up (phase 3: 1991-3). Work characteristics and GHQ were measured at all three phases. RESULTS: Low social support at work and low decision authority, high job demands and effort-reward imbalance were associated with increased risk of psychiatric disorder as assessed by the GHQ at follow up adjusting for age, employment grade, and baseline GHQ score. CONCLUSIONS: Social support and control at work protect mental health while high job demands and effort-reward imbalance are risk factors for future psychiatric disorder. Intervention at the level of work design, organisation, and management might have positive effects on mental health in working populations.

Adult↗
PubMed1993

The competition vogue and its outcomes.

Social security and comprehensive health care financing were developed to protect all citizens and to redistribute money to cover costs. Their inspiration was social solidarity rather than pecuniary self-interest. The United States differed from other countries by continuing a private market in health, with many self-centred and competing providers and insurers; and its prevailing school of health economics deplored the national health insurance and national health services that were universal in other countries and recommended devices that would eliminate "market failure" in health. When health economics grew in Europe during the 1970s and 1980s, the reformers' first presumption was that the voluminous American market-oriented literature must offer answers; but much of it proved superfluous, since European health care systems still had much competition and consumer choice, and they worked better than the reality in the United States. The United States itself has paid a heavy price for turning over health financing policy to the devotees of microeconomics and free markets, and today its serious problems in health are unsolved. So powerful is the pro-competitive ideology that it has now been adopted by the Democratic Clinton Administration, contradicting the heritage of Roosevelt, Truman, and Johnson.

Economic Competition↗
PubMed2004

How (not) to protect genomic data privacy in a distributed network: using trail re-identification to evaluate and design anonymity protection systems.

The increasing integration of patient-specific genomic data into clinical practice and research raises serious privacy concerns. Various systems have been proposed that protect privacy by removing or encrypting explicitly identifying information, such as name or social security number, into pseudonyms. Though these systems claim to protect identity from being disclosed, they lack formal proofs. In this paper, we study the erosion of privacy when genomic data, either pseudonymous or data believed to be anonymous, are released into a distributed healthcare environment. Several algorithms are introduced, collectively called RE-Identification of Data In Trails (REIDIT), which link genomic data to named individuals in publicly available records by leveraging unique features in patient-location visit patterns. Algorithmic proofs of re-identification are developed and we demonstrate, with experiments on real-world data, that susceptibility to re-identification is neither trivial nor the result of bizarre isolated occurrences. We propose that such techniques can be applied as system tests of privacy protection capabilities.

Algorithms↗
PubMed2003

[Social inequality and noise pollution by traffic in the living environment--an analysis by the German Federal Health Survey (Bundesgesundheitssurvey)].

AIM OF THE STUDY: The study deals with the relationship between socioeconomic status and the uneven distribution of noise pollution in residential areas. Based on the social indicators education, occupation, income and an index of socioeconomic status, the study investigates whether people of lower socioeconomic status are more likely to live in busier streets and to be more affected by traffic and noise pollution than others. MATERIAL: The German Federal Health Survey (Bundesgesundheitssurvey, BGS) is a representative survey of the health status of the adult population in Germany. The representative sample in question reflects the opinions of 6,644 individuals aged between 18 and 79 years who were asked to fill in a standardised questionnaire between autumn 1997 and spring 1999. RESULTS: People of lower socioeconomic status are more likely to live in busy to extremely busy main roads and through roads. They feel significantly more often affected by traffic noise pollution. People of higher socioeconomic status are more likely to live in quiet environments. Essentially, all four social indicators reflect the social gradient of noise pollution, but their impact is differently weighted. CONCLUSION: Noise pollution in environments is unevenly distributed, with people of lower socioeconomic status suffering more than others. In view of the increased social burden and assumed vulnerability experienced by lower socioeconomic groups, environmental objectives for protection from noise pollution should be developed which ensure a socially just distribution of environmental noise pollution in addition to avoiding danger to health.

Adult↗
PubMed2004

'Add women & stir'--the biomedical approach to cardiac research!

In conditions shared by women and men, the biomedical model of disease assumes that illness-symptoms and outcomes are biologically and socially 'neutral'. Consequently, up until a decade ago, white middle-aged men were the model subjects in most funded cardiac trials, with the assumption that whatever the findings, the results would also hold true for women. This 'add women and stir' approach has resulted in imbalances in cardiac care and an image of coronary artery disease, which portrays a middle-aged male as its victim. Moreover, cardiac health care has been designed with the male anatomy and male experience of illness in mind, and health promotional measures have been targeted towards men. Women have received these health promotional messages to protect the hearts of men, and have been less likely to modify their own lifestyles in a cardio-protective manner. However, the biological and social differences that exist between women and men, must surely invalidate such biased biomedical assertions, and signify a need to delve beyond the realm of biomedical reductionism for greater insights and understanding. This review examines how scientific reductionism has failed to explore the impact of coronary artery disease on the lives of women and how the gendered image of this disease has privileged the normative frame.

Attitude to Health↗
PubMed1991

Confidentiality for whom?

Confidentiality has been argued to be a cornerstone both of medical and social research encounters, particularly because of the protection it offers for patients and informants. In practice the idea of confidentiality is fractured. Professional interests in the organisation of medical work, and concerns for the collective interest amongst social researchers may lead to individual confidentiality being undermined. In addition discrepancies in the ethical positions and practices of social researchers and those in biomedicine may produce further problems for the maintenance of confidentiality.

Behavioral Research↗
PubMed2001

The precautionary principle in environmental science.

Environmental scientists play a key role in society's responses to environmental problems, and many of the studies they perform are intended ultimately to affect policy. The precautionary principle, proposed as a new guideline in environmental decision making, has four central components: taking preventive action in the face of uncertainty; shifting the burden of proof to the proponents of an activity; exploring a wide range of alternatives to possibly harmful actions; and increasing public participation in decision making. In this paper we examine the implications of the precautionary principle for environmental scientists, whose work often involves studying highly complex, poorly understood systems, while at the same time facing conflicting pressures from those who seek to balance economic growth and environmental protection. In this complicated and contested terrain, it is useful to examine the methodologies of science and to consider ways that, without compromising integrity and objectivity, research can be more or less helpful to those who would act with precaution. We argue that a shift to more precautionary policies creates opportunities and challenges for scientists to think differently about the ways they conduct studies and communicate results. There is a complicated feedback relation between the discoveries of science and the setting of policy. While maintaining their objectivity and focus on understanding the world, environmental scientists should be aware of the policy uses of their work and of their social responsibility to do science that protects human health and the environment. The precautionary principle highlights this tight, challenging linkage between science and policy.

Decision Making↗
PubMed2004

The role of emotional social support in the psychological adjustment of siblings of children with cancer.

BACKGROUND: Siblings of children with cancer are at risk for reduced emotional support. The role of emotional social support in the psychological adjustment of siblings of paediatric cancer patients was examined, in the context of age and gender. METHODS: The sample consisted of two groups of siblings of children being treated for cancer: siblings referred for behaviour problems (n = 47) and a comparison group of non-referred siblings (n = 25). Forty-two were female, and 30 were male. The mean age was 10.31 years (SD = 2.71). Siblings completed measures of depression, anxiety, behaviour, and emotional social support. One parent of each sibling completed measures of sibling's behaviour and anxiety. RESULTS: Siblings who reported more social support endorsed significantly fewer symptoms of depression, anxiety, and fewer behaviour problems, and their parents reported less anxiety and fewer behaviour problems than siblings who reported lower social support. Parents of referred siblings reported significantly more behaviour problems than parents of non-referred siblings. Referred adolescent females reported significantly higher depression scores and were perceived as more anxious than referred adolescent males and non-referred adolescent females. Non-referred younger siblings with high social support were perceived by their parents as having the fewest behaviour problems. CONCLUSIONS: High level of social support appears to play a protective role in psychological adjustment of siblings of paediatric cancer patients, with age and gender as modifying factors. Although not all siblings develop behaviour or emotional problems, it is critical to identify those who do in order to intervene accordingly.

Adaptation, Psychological↗