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PubMedDate not supplied

Just how important is the messenger versus the message? The case of framing physician-assisted suicide.

As a political issue, death and dying topics only sometimes reach the political agenda. However, some issues, such as physician-assisted suicide (PAS) have been highly salient. This article explores attitudes toward PAS by examining the malleability of opinion when respondents are exposed to issue frames and when specific messengers present those frames. We used 4 experimental conditions in a statewide survey and 1 control group, which allowed us to compare the impact of a framed message on opinion as well as that message presented by a specific messenger. Results suggest that support for PAS can be shaped by whether PAS is framed as individual choice or as a matter involving sanctity of life. In addition, we find that specific messengers did not influence opinion on PAS beyond the influence of the issue frame itself, controlling for respondent characteristics such as gender and race. Indeed, the findings indicate that messengers may in fact reduce the intended impact of issue frames of opinion toward PAS.

Data Collection↗
PubMed1991

Gender, migration and social change.

"This paper provides a critical review of existing studies about how migration alters women's position in the course of social change....First, the conceptual and methodological issues that bear on the assessment of changing gender relations are distilled from the existing literature. Second, for heuristic purposes we delineate three alternative outcomes for migrant women using the distribution-redistribution analytical framework....Finally, we provide a selective review of case studies illustrating alternative outcomes for migrant women in Africa and Latin America." (SUMMARY IN FRE)

Africa↗
PubMed2005

Transsexuals and European human rights law.

Sexual identity is a legal status, and as such it is as much dependent on public policy as on self-identification. However, because this status can be crucial to one's role in society, a conflict between the legal status and an individual's perceptions or aspirations creates a dilemma if society is committed to individual freedom. This difficulty can become particularly acute where it is technically possible for an individual to alter some of the factors used socially or legally to determine sexual identity. This paper analyses these difficulties, both from the situation of endocrine disorder and with respect to gender identity. It argues that this distinction in approach may not be a valid basis for different legal treatment. It considers four major issues: the stage at which a change of gender should be recognised; any preconditions to which a legal change of gender should be made subject; whether legal recognition should be made for all purposes or only for specific areas of the law; and the confidentiality of a person's previous sexual identity. The paper particularly analyses the law in the United Kingdom and then considers other jurisdictions before focusing on the treatment of transsexuals under the European Convention on Human Rights.

Europe↗
PubMed2003

Conflicted gender. The case of a woman who believed she was half male and half female.

The author presents the case of a middle-aged woman who had a fantasy that she was half male and half female, which did not emerge until she was well into her analysis. Initially, the analytic work focused on issues of attachment and trust, as the patient was mute and despairing, and unable to verbalize affects or put together a coherent story of her life. Gradually over the course of her analysis, a history of severe emotional neglect and trauma was pieced together--she had been left at the hospital as a newborn because her mother had not wanted a girl. It was only after the establishment of more comfortable and stable connection to the analyst that the conflicts around gender and the boy/girl fantasy came into focus. Two masturbation fantasies, a primitive, non-visualized sensation of sexual insatiability with abdominal throbbing, and a more traditional beating fantasy were also analyzed. The fantasy of being both male and female, which was conscious since childhood, was both a result of and a solution to more basic issues. It was a sign of problems in integration of internal parental identifications, a shaky maternal attachment, and difficulties in dealing with affect. The fantasy reflected a profound sense of being unwanted and unloved and became a narcissistic solution for these troubling feelings. The author details the interplay of constitutional, familial, and psychological factors that contributed to this solution. Because issues of gender were highlighted in this case, their complex relationship with other underlying factors could be appreciated.

Adult↗
PubMed1985

Disability dilemmas and rehabilitation tensions: a twentieth century inheritance.

Although disability has gradually become part of the social justice concept in Western nations since the seventeenth century, and is a current world-wide social concern, it is no way as readily definable or determinable as race, gender, age or even poverty, other issues of social justice. It remains a relative term despite efforts to contain it. The World Health Organization's definition for disability is a restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being, arising as a consequence of physiological, psychological or anatomical impairment. Under the impairment/disability paradigm, rehabilitation interventions aim for the restoration of maximum functional activity or independence. The consequences of impairment and disability can, but do not necessarily, lead to handicaps or conditions of disadvantage, the composite result of individual functional limitations and faults in physical, cultural, social, economic and political environments. Rehabilitation for handicapping conditions then implies not necessarily the restoration of maximum functional activity or independence, but the restoration of maximum social function, including work and family roles. Recent literature on disability and rehabilitation research and policy reflects the complex and expanding context, but the relativity of the concepts involved, particularly the slippage between disability and handicap, create problems of consistently determining and communicating need. For the literature, certain dilemmas are evident in determining and providing for the needs of disabled persons: self-perceived and self-defined need vs bureaucratic standards and statistical definition; resource compensation vs resource enhancement; urban vs rural needs. Closely related to these perplexing problems are tensions in rehabilitation approaches: institutional and community approaches; individual functional improvement and environmental improvement. This paper considers the dilemmas and tensions as reported, and on that basis certain policy issues are tabulated and presented.

Community Health Services↗
PubMedDate not supplied

Difficult dialogues: impact on nursing education curricula.

Efforts to raise consciousness and heighten sensitivity toward the issues of races, class, ethnicity, and gender are being espoused throughout society today. Within higher education there is currently a national debate over whether or not curricula are exclusive of certain ethnic and cultural perspectives. The National League of Nursing (NLN) in 1989 resolved that innovative nursing curricula be developed that (1) enhance caring practices through faculty-student relationships and faculty-faculty relationships that are egalitarian and humane and characterized by cooperation and community building; (2) incorporate social values that recognize diverse life-styles and multicultural and multiracial perspectives; and (3) include contact with or participation by persons at risk including disenfranchised populations such as women, poor, elderly, and homosexual persons. The purpose of this article is to share two faculty members' experience of creating a "difficult dialogue" in a doctoral nursing education course. Generally speaking, difficult dialogues are encountered when academia attempts to include the experiences of white women, women of color, and men of color in the curriculum. The dialogues are difficult because engagement in this type of discourse may lead to feelings of discomfort and uneasiness among faculty and students. Although these feelings were experienced by class participants, the end result was a constructive and powerful learning experience. The willingness of the black students and faculty in the course to share their lived experiences of discrimination and oppression in a white society and the willingness of the white students and faculty to hear a different lived experience from their own was education at its best.(ABSTRACT TRUNCATED AT 250 WORDS)

Communication↗
PubMedDate not supplied

Gender and psychosomatic aspects of ischemic heart disease.

While women and their doctors have traditionally worried about mortality from breast and gynecological malignancies, over the past 5 years they have come to realize that ischemic cardiac disease (IHD) is the number one killer of women in most Western countries. This has led to public and professional education campaigns and a new emphasis on gender and gender-specific research in IHD. Unfortunately, this literature remains poorly developed and much work remains to be done. Even in samples in which there may be sufficient numbers to allow for the evaluation of gender and gender differences, these important analyses have often been overlooked. This article provides a review of what is known about gender and gender differences in psychosocial and behavioral issues in IHD.

Adult↗
PubMed1997

Perspectives of reproductive health.

This issue of Patient Education and Counseling is dedicated to reproductive health. The main focus is infertility as it is experienced in different of our world. In western societies, medical breakthroughs give couples with fertility problems a good chance to have a child. However, in many developing societies adequate medical treatment is only available for the upper classes, and many women keep going to traditional healers. In addition, the social consequences of childlessness are much greater than in western societies. Another focus of this issue is negative experiences regarding pregnancy. A very distressing experience is late pregnancy loss. Late pregnancy loss is different from infertility with respect to the tangibility of an object of grief, though it may also result in permanent childlessness. Other aspects of negative pregnancy experiences are exceptional physical reactions and recurrent induced abortions. Furthermore, two other elements of reproductive health are addressed in this issue: STD among female adolescents and gender aspects of gene technology. Finally, the ramifications of these various aspects of reproductive health on education and counseling are discussed.

Adolescent↗
PubMed1995

Feminist teaching and the older nurse: the journey from resistance through anger to hope.

Some of the material presented in the journals of mature student registered nurses in two nursing research methodology courses are analysed. The classes were taught from a critical feminist perspective; that is, gender, race, sexual orientation and class issues were addressed as the science of ideas was explored. The students kept journals of their experiences throughout the process. While this was not a 'research' project in the usual sense of the word, material evolved which was primarily an evaluation of my teaching approach and their responses to it. Excerpts of this material were kept as they provide rich data providing insights into teaching strategies. Students cannot be identified in this analysis. It was found that, initially, most resisted the ideas of feminist theory, research and praxis. As the classes progressed, many feelings were of anger about the oppression they had experienced in the past at work and personally but had not understood. Finally, towards the end of term, many students expressed hope that they would be able to bring about some social change within the profession as a result of the ideas discussed in classes. However, several students remained unconvinced that feminism was the way to evoke change.

Adult↗
PubMed1999

Patients as teachers: a qualitative study of patients' views on their role in a community-based undergraduate project.

OBJECTIVES: Patients have been used in clinical medical education for many years with, traditionally, a relatively passive role. Following the General Medical Council recommendations for curricular change and the development of more community-based teaching, 'ordinary patients' in the community are increasingly being partnered with undergraduate students for particular projects. Very little research has been undertaken on patients' perceptions of this role. DESIGN: Semi-structured interviews were carried out with 20 people to explore the views of patients taking part in a community-based undergraduate medical student project (the 'patient study') at Newcastle Medical School about their role as teachers of medical students, what they felt they had gained from participating, any problems or concerns and suggestions for change or improvement. SETTING: Newcastle Medical School, UK. SUBJECTS: Second-year medical students. RESULTS: Two major themes emerged. First, patients saw themselves in active roles as teachers: as experts in their medical condition; as exemplars of their condition; and as facilitators of the development of students' professional skills and attitudes. Secondly, patients felt they had benefited from participation, through talking about their problems; learning more about themselves; the satisfaction of helping; and from receiving gifts. In addition, a number of other issues were identified including interpersonal dynamics, gender and ethnic differences, inadequate briefing of participants and whether such community-based patient involvement might, in some situations, be felt to be exploitative. CONCLUSIONS: The study has shown that patients see themselves clearly as having specific contributions to make to medical students' education and training. This has implications for the further development of community-based teaching.

Adult↗
PubMedDate not supplied

Zambia mental health country profile.

This country profile for Zambia was compiled between 1998 and 2002. The objectives of the exercise were to first of all avail policymakers, other key decision makers and leaders in Zambia, information about mental health in Zambia in order to assist policy and services development. Secondly, to facilitate comparative analyses of mental health services between countries. The work involved formation of a core group of experts who coordinated the collection of information from the various organizations in Zambia. The information was later shared to a broad spectrum of stakeholders for consensus. A series of focus group discussions (FGDs) supplemented the information collected. There are various factors that contribute to mental health in Zambia. It is clear from the Zambian perspective that social, demographic, economic, political, environmental, cultural and religious influences affect the mental health of the people. With a population of 10.3 million and annual growth rate of 2.9%, Zambia is one of the most urbanized countries in sub-Saharan Africa. Poverty levels stood at 72.9% in 1998. In terms of unemployment, the most urbanized provinces, Lusaka (the capital city), and the copper-belt are the most affected. The gross domestic product (GDP) is US$3.09 billion dollars while per capita income is US$300. The total budget allocation for health in the year 2002 was 15% while the proportion of the GDP per capita expenditure for health was 5.6%. The HIV/AIDS prevalence rates stand at 20% among the reproductive age group 15-49 years. Political instability and wars in neighbouring states has resulted in an influx of refugees. Environmental factors affecting the country include natural and man-made disasters such as floods and drought, mine accidents, and deforestation. To a large extent in Zambia, people who are mentally ill are stigmatized, feared, scorned at, humiliated and condemned. However, caring for mental ill health in old age is positively perceived. It is traditionally the duty and responsibility of the extended family to look after the aged. Gender based violence (GBV) is another issue. Women, who are totally dependent on their spouses economically, are forced by circumstances to continue living in abusive relationships to the detriment of their mental well-being. In Zambia, the family is considered sacrosanct and the affairs of the family members, private. It is within this context that GBV is regarded as a family affair and therefore a private affair, yet spouse beating has led to depression and in some cases death. In terms of psychiatric services, there are close to 560 beds for psychiatric patients across the country. Common mental disorders found in Zambia are acute psychotic episodes, schizophrenia, affective disorders, alcohol related problems and organic brain syndromes. About 70-80% of people with mental health problems consult traditional health practitioners before they seek help from conventional health practitioners. Over time the number of frontline mental health workers and professional staff has been declining. This is due to the 'brain drain', retirement, death and low output from training institutions. For practicing psychiatrists, only one is available for the whole country. Other key mental health workers such as psychologists, social workers and occupational therapists are also in short supply. All in all, the mental health services situation in Zambia could be described as critical, requiring urgent attention.

Aged↗
PubMed2005

The bioethics of care: widows, monastics, and a Christian presence in health care.

At the beginning of the twenty-first century, with vocations to the Christian religious orders of the West in marked decline, an authentic Christian presence in health care is threatened. There are no longer large numbers of women willing to offer their life labors bound in vows of poverty, chastity, and obedience, so as to provide a real preferential option for the poor through supporting an authentic Christian mission in health care. At the same time, the frequent earlier death of men leaves a large number of widows, some in need of care and some able to provide care. Drawing on the role of widows sketched in 1 Timothy 2, one can envision Christian widows entering a life of prayer and service in health care settings. As female monastics, such widows could reintroduce a salient Christian presence in health care. How one ties this response to the message of 1 Timothy 2 will depend on one's understanding of the status of Scripture, the significance of tradition, the nature of theological epistemology, the meaning of theology, the nature of the Church, and the ontology of gender. The position taken on these issues will define the character of a Christian bioethics of care.

Aged↗
PubMed2005

Abolition of cost-sharing is pro-poor: evidence from Uganda.

OBJECTIVE: To document the effects of the abolition of user fees on utilization of health services in Uganda with emphasis on poor and vulnerable groups. METHODS: A longitudinal study using quantitative and qualitative methods was carried out in 106 health facilities across the country. Health records were reviewed to determine trends in overall utilization patterns and use among vulnerable groups. A modification of wealth ranking as defined by the Uganda Poverty Participatory Assessment Project was used to categorize households by socio-economic status in order to compare utilization by the poor against that of other socio-economic groups. FINDINGS: There was a marked increase in utilization in all population groups that was fluctuating in nature. The increase in utilization varied from 26% in public referral facilities in 2001, rising to 55% in 2002 compared with 2000. The corresponding figures for the lower level facilities were 44% and 77%, respectively. Increase in utilization among the poor was more than for other socio-economic categories. Women utilized health services more than men both before and after cost-sharing. Higher increases in utilization were noted among the over-five age group compared with the under-fives. There were no increases in utilization for preventive and inpatient services. With respect to quality of care, there were fewer drug stock-outs in 2002 compared with 2000 and 2001. There was no deterioration of other indicators such as cleanliness, compound maintenance and staff availability reported. CONCLUSION: The study suggests that there is a financial barrier created by cost-sharing that decreases access to services, especially among the poor in Uganda. However, further studies are needed to clarify issues of utilization by age and gender.

Age Factors↗
PubMed2003

Impact of trends in primary, secondary, and postsecondary education on applications to medical school. I: gender considerations.

The number of applications to medical schools has been declining at a time when attention is beginning to focus on the potential need to expand the infrastructure of medical education to meet the nation's growing consumption of health care services. To gain an understanding of the dynamics affecting the availability of medical applicants, the author used data from several decades to study the transitions that occur throughout the process of education-from primary and secondary education to four-year colleges and, ultimately, to medical school application-from the standpoint of individuals' gender. (A companion article in this issue reports the findings of a parallel study from the standpoint of individuals' race and ethnicity.) A progressive erosion was found in the level of participation of men in postsecondary education over the past 25 years, and a parallel decline was observed in the percentage of baccalaureate men who sought further education at the doctoral level, including medicine. These dynamics have occurred aside rising levels of achievement of girls in early education, increasing numbers of women in four-year colleges, and high levels of interest among college women in medical education. But despite this peak of interest, women baccalaureates have displayed a low frequency of application to medical schools. Based on these observations and on population trends among 20 year olds, it is projected that the number of women applying to medical school will continue to increase, but only modestly, while the number of men who apply will remain relatively unchanged. The resulting growth will be sufficient to alleviate the recent paucity of medical school applications, but it will not be adequate for the needs that any significant expansion of medical school seats will create nor for the numbers of physicians that a predominantly female profession will require.

Adult↗
PubMed2004

[Multiple causes of death due to non-communicable diseases: a multidimensional analysis].

This study approaches multiple causes of death to analyze the associations between causes of death from non-communicable diseases, age, and gender in 3,106 death certificates issued in 1998, comprising individuals who were 20 years old or over and resided in Belo Horizonte, Minas Gerais State, Brazil. The multiple cause of death approach, by considering all the diagnoses mentioned in the death certificate, highlights conditions that are underestimated by the underlying-cause approach that has traditionally been used in mortality statistics. Association of causes of death was analyzed using the multidimensional data analysis method with the multiple correspondence factor analysis technique. The results reinforce the usefulness of the multiple causes approach to improve information on mortality and demonstrate important associations, such as hypertension and cerebrovascular diseases, obesity and diabetes or ischemic heart diseases, allowing to plan, prioritize, and reevaluate health actions.

Adult↗
PubMed1992

Medical students' knowledge of and exposure to cleft palate.

To compare the knowledge and experience of medical students in 1989 with that of those surveyed in 1973, a questionnaire about the various aspects of cleft palate was completed by 209 medical students from West Virginia University and the Louisiana State University Medical Center at Shreveport and New Orleans. Results revealed that 1989 students were more familiar with the embryology of cleft palate, racial and gender differences, and intellectual and psychologic issues (p less than .05). In contrast, the 1973 students were more able to define cleft palate, submucous cleft palate, and pharyngeal flap. There was no difference between the two groups of students in the amount of clinical exposure to cleft palate. These findings support the need for greater emphasis on cleft palate at the pre- and postdoctoral levels, as well as within continuing education programs. As part of current programs, the standard of practice of multidisciplinary team management for an individual with cleft palate should be underscored.

Cleft Palate↗
PubMed1996

Outcome of schizophrenia: the Madras longitudinal study.

OBJECTIVE: The aim of the study was to determine the clinical outcome in a group of first-episode schizophrenic patients on a 10-year follow-up. The social, demographic and clinical variables associated with poor outcome and gender differences in outcome were other issues addressed. METHOD: Ninety patients fulfilling Feighner's and ICD-9 criteria for schizophrenia, at Madras, India, were included for a 10-year follow-up. The Present State Examination and the Psychiatric and Personal schedule were administered at intake and at the end of every year. Clinical outcome was considered as a combination of the pattern of course and the presence of positive symptoms during year 10. RESULTS: After 10 years, 76 of the 90 patients included were followed up, giving a follow-up rate of 84%. The clinical outcome was good in nearly 75% of the patients with almost all symptoms showing a steep decline at the end of 10 years. Fifty-nine subjects were asymptomatic at the end of the follow-up period and 12 were ill during the entire 10th year. Sexual, religious and grandiose delusions and flat affect at inclusion predicted a poor clinical outcome. More males had a poor outcome and spent a longer time in a psychotic state. CONCLUSIONS: There is evidence of a good outcome in the majority of first-episode schizophrenic patients after 10 years in keeping with other reports from developing countries. Certain variables at inclusion predicted a poor clinical outcome and males had a poorer outcome than females.

Adult↗
PubMedDate not supplied

Insights into managed care--operational, legal and actuarial.

Understanding the operational, legal and actuarial dimensions of managed care is essential to developing managed care contracts between managed care organizations and individual health care providers or groups such as provider-sponsored organizations or independent practice associations. Operationally, it is important to understand managed care and its trends, emphasizing business issues, knowing your practice and defining acceptable levels of reimbursement and risk. Legally, there are a number of common themes or issues relevant to all managed care contracts, including primary care vs. specialist contracts, services offered, program policies and procedures, utilization review, physician reimbursement and compensation, payment schedule, terms and conditions, term and termination, continuation of care requirements, indemnification, amendment of contract and program policies, and stop-loss insurance. Actuarial issues include membership, geography, age-gender distribution, degree of health care management, local managed care utilization levels, historical utilization levels, health plan benefit design, among others.

Actuarial Analysis↗