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PubMed2004

Sexually transmitted diseases in adolescents: biologic, cognitive, psychologic, behavioral, and social issues.

A large and complex array of risk and protective factors influence adolescents' sexual behavior and their risk for sexually transmitted diseases. Programs designed to reduce sexually transmitted diseases in adolescents should take a focused and integrated approach that addresses the modifiable biologic, cognitive, psychologic, behavioral, and social issues affecting adolescent sexual risk.

Adolescent↗
PubMed2004

Social capital and collective efficacy in Hungary: cross sectional associations with middle aged female and male mortality rates.

OBJECTIVES: Social capital, collective efficacy, and religious involvement have each been linked to population health. This study examined the relations between these measures and male/female mortality rates in Hungary. DESIGN: Cross sectional, ecological study. SETTING: 150 sub-regions of Hungary. PARTICIPANTS AND METHODS: 12643 people were interviewed in 2002 (the "Hungarostudy 2002" survey). Social capital was measured by lack of social trust, reciprocity between citizens, and membership in civil organisations. Collective efficacy was measured by survey items from the Project on Human Development in Chicago Neighborhoods. Religious involvement was measured by church attendance. MAIN OUTCOME MEASURE: Gender specific all cause mortality rates for the middle aged population (45-64 years) in the 150 sub-regions of Hungary, provided by the Central Statistical Office (CSO). RESULTS: Social capital, collective efficacy, as well as religious involvement were each significantly associated with middle age mortality. After education, collective efficacy showed the strongest association with mortality in both men and women. Among men, socioeconomic status, collective efficacy, social distrust, competitive attitude, reciprocity, and membership of civic organisations explained 68.0% of the sub-regional variations in mortality rates. Among women the same variables explained only 29.3% of the variance in mortality rates. Religious involvement was protective among women. CONCLUSION: Collective efficacy and social capital are significant predictors of mortality rates in both men and women across sub-regions of Hungary. Gender differences in the relative importance of social factors may help to explain the differential impact of economic transformation on mortality rates for men and women in Central-Eastern European countries.

Cross-Sectional Studies↗
PubMed2006

Do competence skills moderate the impact of social influences to drink and perceived social benefits of drinking on alcohol use among inner-city adolescents?

Only a few studies have found competence skills to be a protective factor against adolescent alcohol use; others did not find a direct effect on alcohol. A possible reason for this is that competence skills may moderate the effects of risk factors for alcohol use and that aspect has not been examined often or in a longitudinal design. This study tested whether several competence skills served either as direct protective factors against alcohol use or moderators of the impact of social risk factors on alcohol use. Participants (N = 1318) completed questionnaires that included measures of decision-making skills, refusal skill techniques, resisting media influences, friends' drinking and perceived social benefits of drinking, as well as current drinking amount and future drinking at baseline, one-year follow-up and two-year follow-up. Data analyses were conducted using multi-level mixed effects generalized linear models with random intercept. All the competence skills and the risk factors predicted current and future drinking. Several significant interactions were found between (1) perceived social benefits of drinking and decision-making skills, (2) perceived social benefits of drinking and refusal skill techniques and (3) friends' drinking and refusal skill techniques. Competence skills served as protective factors, as well as moderators. One possible reason that competence enhancement approaches to alcohol prevention are effective may be due to the inclusion of the competence skills component.

Adolescent↗
PubMed2001

Let the consumer decide? The regulation of commercial genetic testing.

OBJECTIVES: The development of predictive genetic tests provides a new area where consumers can gain knowledge of their health status and commercial opportunities. "Over-the-counter" or mail order genetic tests are most likely to provide information on carrier status or the risk of developing a multifactorial disease. The paper considers the social and ethical implications of individuals purchasing genetic tests and whether genetic information is different from other types of health information which individuals can obtain for themselves. DESIGN: The discussion is illustrated by findings from a questionnaire survey of university students as potential consumers. Topics covered included what health tests they had already used, expectations of genetic tests, willingness to pay, who should have access to the results and whether there need to be restrictions on such tests. SAMPLE-Six hundred and fifteen first-year students in the universities of Leuven, Cardiff, Central Lancashire, Vienna and Nijmegen studying either medicine or a non-science subject. RESULTS: Students were enthusiastic about genetic tests and had high expectations of their accuracy and usefulness but most thought they should be available through the health service and a minority thought that some tests, for example for sex selection, should not be available at all. There were few differences in responses by sex or subject of study but some by country. The paper also considers ethical and social issues outside the scope of a questionnaire survey of this type. CONCLUSION: To address some of these issues the sale of genetic tests to individuals can be made subject to ethical guidelines or codes of practice, for example to protect vulnerable groups, but there are fundamental social and ethical questions which such guidelines cannot address.

Access to Information↗
PubMed2004

Ethical issues in social research: difficulties encountered gaining access to children in hospital for research.

BACKGROUND: This paper recounts the difficulties experienced when the authors sought access to children in hospital for social research interviews. These were part of a 2-year study, funded by the Joseph Rowntree Foundation, aiming to explore the numbers, circumstances and experiences of children who spend prolonged periods in health care settings. METHODS: As the intention was to carry out 'guided conversations' with 24 young people in various different NHS locations, permission to do so was sought from a multi-site research ethics committee (MREC), and from several local research ethics committees (LRECs). Agreement was then necessary from NHS trusts, which were asked to nominate a liaison person to help identify and recruit children to the study. Consent was also required from individual parents and children. A series of unexpected delays encountered during this process are discussed in some detail. Eventually a sample of 15 children was achieved. DISCUSSION: The second part of the paper locates this experience within a wider context, noting that similar difficulties gaining access to children in NHS settings have recently been reported by other social researchers. Several possible reasons for this trend are identified and discussed. These relate to the role of MRECs and LRECs in screening social research proposals, recently implemented legislation about data protection, heightened concerns within the NHS about confidentiality and consent, and increasing awareness of the risk of child abuse in health care settings. CONCLUSION: Finally, some suggestions for facilitating the access process are discussed. They include the sensitive and appropriate application of research governance frameworks to social research - including studies within health care settings. Ethical considerations and adequate protection of children are vital but, the authors argue, wherever possible children themselves should be encouraged to decide whether or not to participate in research. In addition, unnecessarily complex access procedures may adversely affect research outcomes.

Attitude↗
PubMed2005

Suicidality in African American men: the roles of southern residence, religiosity, and social support.

The rise in suicide by African Americans in the United States is directly attributable to the dramatic, nearly three-fold increase in suicide rates of African American males. Gibbs (1997) hypothesized high social support, religiosity, and southern residence are protective factors against suicidality for Black people. This hypothesis was tested among 5,125 participants from the National Comorbidity Survey; 299 were African American males. In this study we hypothesized that there would be significantly lower suicidality in the South, and social support and religiosity would mediate this relationship. Our results indicate that Southern region is indeed a significant predictor of suicidal symptoms in African American men, such that suicidal symptoms were lower in the South, but religiosity and social support did not account for this effect. Other potential mediators were also examined.

Adolescent↗
PubMed1996

A comparison of aggressive-rejected and nonaggressive-rejected children's interpretations of self-directed and other-directed rejection.

The hypothesis that aggressive-rejected children are unaware of their social status because they are self-protective when processing negative peer feedback was tested in 3 studies. In Study 1, fourth-grade girls and boys were asked to name peers they liked or disliked, as well as peers they thought liked or disliked them. Comparisons of aggressive-rejected, nonaggressive-rejected, and average status groups revealed that aggressive-rejected children were more unrealistic in their assessments of their social status than were nonaggressive-rejected children. In Study 2, rejected and average boys identified in Study 1 were asked to name who they thought liked or disliked other children from their classroom. Comparisons of perceived and actual nominations for peers revealed that aggressive-rejected children were able to assess the social status of others as well as did nonaggressive-rejected and average status children. Because the difficulties aggressive-rejected children demonstrated in Study 1 did not generalize to judging the status of others in Study 2, the self-protective hypothesis was supported. Study 3 provided a parallel test of this hypothesis under more controlled conditions. Subjects from Study 2 viewed other children receiving rejection feedback from peers in videotaped interactions and received similar feedback themselves from experimental confederates. While all subjects rated self-directed feedback somewhat more positively than other-directed feedback, aggressive-rejected subjects had the largest self-favoring discrepancy between their judgments of self- and other-directed feedback. These findings also suggest that aggressive-rejected children may make self-protective "errors" when judging other children's negative feelings about them. Ethnicity differences in evaluating peer feedback emerged in Studies 1 and 3, raising questions about the impact of minority status on children's evaluations of rejection feedback.

Aggression↗
PubMed2005

Acculturation as a predictor of the onset of sexual intercourse among Hispanic and white teens.

OBJECTIVE: To investigate ethnic differences in onset of sexual intercourse among Hispanic/Mexican American and white adolescents based on acculturation. DESIGN/METHODS: Preprogram survey data from 7270 Hispanic or white teens in 7th to 12th grade involved in the Arizona Abstinence-Only Education Program were used to predict the probability of onset of sexual intercourse based on age, sex, family structure, program location, religiosity, free school lunch, grades, rural residence, acculturation, and ethnicity. Specific attention was given to the influence of acculturation among Hispanic teens. The primary language spoken by the respondents (English, Spanish, or both) was used as a proxy measure for acculturation. RESULTS: Hispanic youth were at a greater risk for experiencing onset of intercourse than white youth, while controlling for all other predictors (odds ratio [OR], 1.40 [95% confidence interval (CI), 1.21-1.63]). This risk was amplified for highly acculturated Hispanic teens (OR, 1.69 [95% CI, 1.43-1.99]). However, less acculturated Hispanic youth were actually less likely to have experienced first intercourse than white youth (OR, 0.59 [95% CI, 0.42-0.82]), English-speaking Hispanic youth (OR, 0.35 [95% CI, 0.25-0.49]), or bilingual Hispanic youth (OR, 0.45 [95% CI, 0.31-0.64]). CONCLUSIONS: Low acculturation emerges as a significant protective factor while controlling for other social and cultural factors, in spite of the increased risk of initiating sexual intercourse for Hispanic teens overall. Hispanic Spanish speakers were least likely to have initiated intercourse, while Hispanic English speakers were the most likely.

Acculturation↗
PubMed1992

Prevalence of smoke detectors and safe tap-water temperatures among welfare recipients in Memphis, Tennessee.

The poor are at high risk for fire- and scalding-related injuries and deaths, many of which could be prevented by installing smoke detectors and reducing residential tap-water temperatures to safe levels. The goal of this study was to measure the prevalence of smoke detectors and safe tap-water temperatures among welfare recipients and compare subjects living in safe and unsafe homes. We interviewed 109 black women residing in inner-city Memphis who were receiving Aid to Families with Dependent Children and inspected their homes for functional smoke detectors and safe tap-water temperatures. Of the 533 residents reported to live in the homes visited for this study, 53.1% were not protected by smoke detectors. More crowded residences were substantially more likely to lack detectors. Most of the smoke detectors which were present were provided by landlords. Of 69 smoke detectors examined, 17.4% did not work. Of the 153 children age 0-5 years living in the homes we visited, 79.1% lived in residences with excessively hot tap water (> 54 degrees C). We conclude that additional efforts are needed to increase the use of smoke detectors and to decrease excessively hot tap water in the homes of welfare recipients.

Adolescent↗
PubMed2006

Barriers of HIPAA regulation to implementation of health services research.

Although many perspectives on the impact of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) on health services research have been wide spread, little empirical evidence has been reported about HIPAA-related barriers during the implementation of research projects. Using three cases of health services research projects, this study examined practical barriers created by HIPAA regulation. During the stage of implementation of the three projects, we experienced some HIPAA-related concerns, previously raised in the field of health services research. We found that technically complicated consent forms and privacy protection forms as well as socially-sensitive clinical conditions make patients less willing to participate in research projects; concerns about safety of patient medical information makes health organizations more hesitant to let researchers have access to the patient's information, especially through electronic transfer; more restrictive IRB processes and challenging patient recruiting processes make health services researchers reluctant to go through the process; and as a result, they may compromise with the scientific soundness of the project. Overall, HIPAA complicates the research process and requires more resources and longer time to conduct research.

Chicago↗
PubMed2004

[General practitioners' health care for disabled patients: a survey among a panel of general practitioners in Southeastern France, in 2002].

OBJECTIVES: This article presents a study on General Practitioners' (GPs) knowledge, attitudes and practice towards disabled patients. MATERIAL: A sample of 600 private general practitioners practising in Southeastern France was selected in 2002 with a random sampling approach stratified according to age, sex, and size of the urban unit. METHOD: A standardised questionnaire was used to collect data by telephone. Results are presented as percentages. Comparisons used Pearson's chi2 test. RESULTS: Ninety percent of the GPs reported that they had to provide social assistance to their disabled patients (protecting their rights, administrative assistance, family counselor, etc.) as well as coordinating care by various other professionals. GPs frequently reported the presence of barriers that compromised the health care of disabled patients: lack of information (62.8%), time (50.2%), co-ordination between health professionals (37.7%), and training (37.7%), as well as communication problems (20.7%) and the need for assistance in clinical examinations (16.2%). More than 25% of the GPs suggested breast cancer screening (27.6%), contraceptive prevention (29.5%) or hepatitis B vaccination (29,3%) less often to their disabled than non disabled patients and 25.8% reported they had not evaluated the patients' dependency levels. CONCLUSION: This study suggests that GPs face several barriers in caring for disabled persons. A lack of knowledge may explain inappropriate care for this population. GPs need more support and guidance in dealing with disabled patients, and coordination with other health professionals must be encouraged.

Adult↗
PubMed2005

Development of mental health dysfunction in childhood epilepsy.

A marked prevalence of mental health dysfunction in childhood epilepsy has been documented in the literature. While several individual risk factors have been identified, which are statistically associated with an impaired mental health outcome, there is a lack of knowledge on the pathways taken by these risk factors on disease development and treatment. The relevant literature of the last decade will be reviewed in this paper to provide evidence for the conceptual framework presented here. Thus, the emergence of mental health dysfunction in childhood epilepsy is analyzed under three levels. Pathogenetic causes: These involve both the underlying CNS pathology and the associated epilepsy disorder characterized by specific time of onset duration type and severity. Mediators and moderators connecting causes to outcomes: These comprise, firstly, the differentiation between the intervening role of anti-epileptic drugs and their positive psychotropic impact via suppression of seizure activity and transient cognitive impairments, as against their negative psychotropic side-effects; secondly, the psychological processes of adaptation which entail responding to three major demands (adherence to treatment requirements, exercising self-control and lifestyle modification to reduce seizure activity, and coping with the psychosocial stressors secondary to living with epilepsy); thirdly, the age-dependent level of neurocognitive and behavioral functioning; and, fourthly, contextual risks and protective factors within the family and social environment. Mental health outcome: This encompasses three major domains: risks for learning disability, for impairments of health-related quality of life, and for psychopathology. The proposed framework serves the development and validation of hypotheses and can be applied to testing procedures aimed at investigating the emergence of mental health dysfunction in childhood epilepsy. On the scientific level, it provides an appropriate tool to approach childhood epilepsy in general, whereas on the clinical level, it facilitates the assessment and management of individual patients.

Adaptation, Psychological↗
PubMed2006

Pregnancy: physiologic changes and considerations for dental patients.

Human gestation is a period of dynamic physiologic changes designed to support the development fetus. Systems affected include the respiratory, gastrointestinal, circulatory, and musculoskeletal. These alterations influence the patient's general health and make her prone to develop complications unique to pregnancy. Such complications include pre-eclampsia, gestation diabetes, and pregnancy tumors. The fetus's development is also affected by its mother's health, social habits, and medication usage. To protect both the mother and unborn child, dental professional may need to incorporate maternal counseling, treatment modifications, or changes to their customary medication repertoire.

Dental Care↗
PubMed2005

Children's exposure to environmental pollutants and biomarkers of genetic damage. I. Overview and critical issues.

In the last decade, molecular epidemiological studies have provided new perspectives on studying environmental risks in pediatric populations, based on the growing understanding that children may be more susceptible to toxicants than adults. Protecting children's health is a social priority, and specific research programs have been initiated with this purpose in the United States and Europe. These programs address the development of (i) less invasive methods for biological specimens collection, (ii) specific tools for interpretation and validation of biomarkers, (iii) methods for translating biomarker results into intervention strategies and for integrating them with environmental monitoring and health data, (iv) optimal ways to obtain consent and provide information to children and/or their parents participating in the studies and (v) techniques for the effective communication with policy makers and the public. Critical issues in children's environmental research discussed in this paper include specific needs of study design, exposure assessment, sample collection and ethics. Special consideration is given to the autonomy of the child in giving consent, the details and nature of the information provided, and the need to warrant controlled access to sensitive information. The use of incentives such as gifts and payment to ensure the participation of school-aged children is specifically discussed. Examples of field studies that are focused on the effects of pesticides, air pollution and formaldehyde are used to illustrate advantages and limitations of biomarker studies in children.

Biomarkers↗
PubMed1982

Long-term functional results of urinary tract reconstruction in childhood.

When reviewing the important long-term parameters of urinary tract reconstruction in childhood, one must consider the protection of renal function, maintenance of social continence and freedom from urinary tract infection as paramount. The 3-year assessment of 25 patients who underwent urinary tract reconstruction for a variety of underlying conditions is presented in terms of renal function, social continence and urinary tract sterility. The underlying pathological condition in our patients was weighted toward children with obstructive uropathy rather than neurogenic vesical dysfunction, and the most common form of diversion was an ileal conduit. Maintenance of renal function was achieved in 21 of our 25 patients (84 per cent). All 8 children (100 per cent) who underwent reconstruction for neurogenic vesical dysfunction have maintained preoperative renal function, while only 12 of the 17 children originally diverted for obstructive uropathy (75 per cent) have done well with reconstruction. Social continence with or without intermittent catheterization has been achieved in 23 of the 25 patients (92 per cent) and sterile urine has been maintained in 22 of the 25 patients (88 per cent). Factors involved in the success or failure of reconstruction are discussed, and observations toward future selection are made from this data base.

Adolescent↗
PubMed2003

Ethical issues in living renal donation.

The widespread success of living renal transplantation has given the medical community both the opportunity and the responsibility of establishing social and ethical guidelines for the protection of donors and the treatment of recipients. While the prospects of treating more patients with organ transplant is exciting, the demand still far outpaces the supply. It is the responsibility of the transplant community and individual transplant centers to maintain a high level of integrity and ethical practice so that living renal transplantation can continue to be a viable and effective treatment for renal failure.

Fees and Charges↗