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PubMed2002

Relationships, not boundaries.

The authors find it more useful to pay attention to relationships than to boundaries. By focusing attention on bounded, individual psychological issues, the metaphor of boundaries can distract helping professionals from thinking about inequities of power. It oversimplifies a complex issue, inviting us to ignore discourses around gender, race, class, culture, and the like that support injustice, abuse, and exploitation. Making boundaries a central metaphor for ethical practice can keep us from critically examining the effects of distance, withdrawal, and non-participation. The authors describe how it is possible to examine the practical, moral, and ethical effects of our participation in relationships by focusing on just relationships rather than on boundaries. They give illustrations and clinical examples of relationally-focused ethical practices that derive from a narrative approach to therapy.

Communication Barriers↗
PubMed2001

A critique of research on the use of activities with persons with Alzheimer's disease: a systematic literature review.

TOPIC: The topic of this paper concerns the use of therapeutic activities with persons with Alzheimer's disease (AD). PURPOSE: The purpose is to present a critique of the research on these activities, with an emphasis on methodology. ORGANIZING CONSTRUCT AND SCOPE: Nursing literature identifies a number of purposes for activities for persons with AD. Activities should be therapeutic, enhance quality of life, arrest mental decline, and generate and maintain self-esteem. Other purposes of activities for this population are to create immediate pleasure, re-establish dignity, provide meaningful tasks, restore roles, and enable friendships. Activities may be more important to the psychological state of well-being of persons with dementia than the general physical and social environments in which they live. SOURCES: The literature reviewed was identified with the use of computer data bases (Medline - 1991-March 2001; Cumulative Index of Nursing and Allied Health Literature (CINAHL) - 1991-March 2001; and PsychLit - 1988-March 1999). In addition, data bases of Science Citation Index and Social Science Citation Indexes as they appear in the computer base, Web of Science, were searched for 1992-2001. The time period for each search was determined by the manner in which the literature was grouped for inclusion in the particular database. Hand searches of 11 selected journals included the years 1993-2001. The search dates were selected to reflect the time period when the largest number of studies on activities and AD have appeared in the professional literature. We critique a total of 33 studies. CONCLUSIONS: While researchers have demonstrated interest in the use of activities with persons with AD, theoretical and methodological difficulties, unclear findings and gaps exist, including a lack of emphasis on gender, ethnic, racial or cultural differences. Sampling issues involving diagnosis and staging complicate the research on individuals with AD. Case studies, single subject experimental designs, and tightly controlled quasi-experimental and experimental designs are needed to advance knowledge in this important area.

Alzheimer Disease↗
PubMed2003

Differences in the justification of choices in moral dilemmas: effects of gender, time pressure and dilemma seriousness.

The effects on moral reasoning of gender, time pressure and seriousness of the issue at hand were investigated. In Experiment 1, 72 university students were presented with moral dilemmas and asked what actions the actors involved should take and to justify this. Women were found to be more care-oriented in their reasoning than men, supporting Gilligan's moral judgment model. Both time pressure and consideration of non-serious as opposed to serious moral dilemmas led to an increase in a justice orientation compared with a care orientation in moral judgments. In Experiment 2, a similar task was given to 80 persons of mixed age and profession, and the participants' moral reasoning was coded in terms of its being either duty-orientated (duty, obligations, rights) or consequence-oriented (effects on others). Men were found to be more duty-oriented than women, and time pressure to lead to a greater incidence of duty orientation.

Adult↗
PubMed2002

[Representative survey of german people concerning enlightenment and patient directive in a case of terminal illness].

The basic principles dealing with euthanasia (1998) as expressed by the German Association of Doctors states that in advance written directives are of "substantial help for the doctor in his or her actions". This requires, however, wide proliferation of patient directives. Hence it was important to ascertain the prevalence of such directives in the German population, as well as the relationship to the wish for enlightenment in terminal illness and diseases in their final stages. This was accomplished in December 1998 using 2050 people obtained with the Random-Route-Procedure (1024 from the new German states, 1013 from the old German states). The sample was obtained from the opinion research institute USUMA with ages ranging between 14 - 92. The main results from this representative survey represent an important record of the status quo with respect to opinion shaping of patient autonomy. 16 % of this survey expressed the wish not to be fully enlightened in the case of a terminal illness or they wished for a clarification to be given to the family only. This result shows that part of the population still holds on to their right of no knowledge. 59.1 % expressed the wish for a complete and immediate enlightenment. The other 24.9 % desired a careful step-by-step presentation of information. The high percentage of those who desired information and enlightenment is in contradiction to the small 2.5 % of patients who have actually written advance directives. These empirical results are consistent with the clinical experience of many doctors and represents the decision of the "representational" doctors for the current ethical regulation of patient directives as an ideal idea. Since 71.9 % of those surveyed had never before thought about this issue conclusions are drawn regarding patient consultations. Gender and East/West differences are also shown.

Adolescent↗
PubMed2005

Discussant response to 'Does the acoustic waveform mirror the voice?'.

The acoustic waveform that reaches the two ears of a listener can convey the intended message. Over the telephone, this waveform is the only source of information from the speaker, since the listener is out of visual contact; indeed, in this situation the acoustic waveform itself is restricted in its frequency content. Whilst the listener can infer much about the speaker from the acoustic waveform, including the speaker's age, gender, nationality, dialect, and emotional state, the issue under consideration here is the extent to which quantitative analysis of the acoustic waveform can provide useful information about a speaker's voice. This paper was presented as an Invited Discussant Response, at the Pan-European Voice Conference (PEVOC6) in London, to the question posed in Ternström's Invited Keynote Lecture 1: Does the acoustic waveform mirror the voice?

Humans↗
PubMedDate not supplied

HIV-AIDS in Nepal: the coming crisis.

The number of officially reported cases of HIV infection and of AIDS in Nepal remains low in comparison with numbers in many other Asian countries. But Nepal's open border with India (where HIV infection rates are rapidly rising) and the high level of physical mobility within Nepal and abroad, associated with widespread labor migration and encouraged by the recent development of road transport, means that there is a real danger of a rapid spread of HIV within Nepal. The major means of infection is through heterosexual encounters involving male clients and female sex workers, but other sections of the population are also at risk from infection. Media attention has focused on female sex workers, particularly those who have worked in India, but the issue is far broader than this. Social and economic factors forcing or encouraging young men and women to seek employment away from home underlie the widespread growth of ¿the sex industry¿ and the ¿trafficking¿ of girls and young women. The state's capacity to respond effectively is limited, in part through lack of resources; international agencies are supporting local nongovernmental organizations in a variety of activities designed to ¿educate¿ and to ¿support¿ those at risk; but in the last analysis, it is the local communities from which young men and women migrate and to which they return that are obliged to find ways of coping. Sometimes these communities are supportive of the victims, sometimes not. The spread of HIV-AIDS is not just a ¿health¿ issue, but an issue of economic and social development, of gender relations and of human rights.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Domesticity in Middle Dutch 'secrets of men and women'.

This is an introductory analysis of a group of Middle Dutch texts about the 'Secrets' of female health and human procreation, which date from the fourteenth and fifteenth centuries. Although at first sight little more than translations and adaptations of two Latin treatises widely known as Trotula and Secreta mulierum, the texts afford glimpses of their cultural context. They reveal a variety of traits which converge on the ordinary home, rather than on the castle, church, or university. The notion of secrecy was not a mere cliché but connected, perhaps more deeply than in other languages, with the intimacy of the family. In their phraseology as well as in their manipulations of the sources, by which they shaped the treatment of sexual issues, the writers appeared relatively unencumbered by gender polarities, heavy moralizing, and scholastic rationalization. They addressed women and men, not only readers but also illiterate listeners, and they seemed particularly attuned to the household both in the practicality of gynaecological guidelines and in the earliness of sexological information. Many hints yield a cumulative impression - inviting further thought - that the Middle Dutch 'Secrets' illuminate a special appreciation for the 'domestic' values of sexual harmony, enjoyment, and privacy.

Belgium↗
PubMed1994

Meaning and purpose in the lives of persons with AIDS.

Little research has been reported that explores meaning-discovery and meaning-making in persons with AIDS. Self-transcendence experiences, as proposed by Reed (1991), may lead to maintenance or restoration of mental health in persons facing end-of-life issues. Nurses who work with persons with life-threatening illness, such as men and women with AIDS, have opportunities to facilitate choices that lead to experiences from which meaning and emotional well-being may be obtained. This study used a phenomenological approach to describe experiences of 10 men and 10 women with AIDS that led to feelings of increased self-worth, purpose, and meaning in their lives. Participants provided oral or written descriptions of experiences associated with feelings of increased connectedness with others, sense of well-being, and hope for longer life. Data were analyzed using Colaizzi's phenomenological technique (1978). Although men and women with AIDS faced some of the same issues, their responses were different. By incorporating gender and individual differences, nurses may be better able to create therapeutic exchanges in which self-transcendence views and behaviors are fostered in both men and women with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Group discussions with parents have long-term positive effects on the management of asthma with good cost-benefit.

AIM: To investigate if an intervention with extra information and support in a group setting to parents of preschool children could improve adherence and clinical outcome. METHODS: This is a controlled, prospective study where the parents of 60 newly diagnosed preschool asthmatic children aged 3 mo-6 y were randomized to either a control group or to an intervention that consisted of four group sessions in close connection with the diagnosis. The basic education on asthma and the written treatment plan were the same in both groups. The outcome measures were questionnaires to the parents and classification of the children according to symptoms and medication. The adherence rate and the burden of asthma were calculated with the help of diaries and weighing of the MDIs used between 12 and 18 mo after inclusion. RESULTS: The follow-up rate was 85% after 18 mo. The parents' presence in the sessions was around 70%, with no gender difference. The parents' view on adherence issues improved significantly in the intervention group. In the control group, 30% had poor adherence compared to 8% in the intervention group (p=0.015). Both the parents and the paediatricians underestimated the number of children with poor adherence. The children in the intervention group had significantly fewer exacerbation days during the last 6 mo-2.1 compared to 3.9 d/child-although they had lower inhaled steroid doses after 18 mo. An economic calculation showed that the intervention was profitable. CONCLUSION: This intervention resulted in an improvement in the parents' view on adherence, in the measured adherence rates and in the clinical outcome.

Adult↗
PubMed1993

Ethics, empathy, and gender in health care.

The changes that have taken place in medicine over the past few decades have challenged our views about the responsibilities and obligations of those providing health care and about their relationships with their patients. The demands brought by technologic advances and economic concerns have tested our ability to practice humane, empathic, and ethical medicine. This paper addresses the connection between ethics and empathy in the context of our current health care system. The author reviews the concept of empathy and argues that ethical medicine is empathic medicine. Since gender differences in health care needs and disparities in treatment have been identified, gender serves to focus some of the issues and exemplify some concerns about empathic and ethical practice.

Biomedical Research↗
PubMed1994

Gender-biased language in learning disability textbooks.

The purpose of our study was to explore whether gender-biased language exists in two editions of popular learning disabilities (LD) textbooks by a female author and a male author. First, we examined whether gender-biased language (as measured by the frequency of gender-specific pronouns) was present in LD textbooks as a function of the author's gender and discovered that the male author exhibited approximately a 7:1 ratio in his use of masculine to feminine pronouns. In contrast, the female author demonstrated no significant difference in her use of gender-specific pronouns. Second, we investigated whether the degree of gender-biased language has changed in different editions over the past 5 years and found a significant change only in the use of neutral pronouns by the male author. The existence of gender-biased special education textbooks raises the issue of the possible influence that such material may have on professional expectations concerning students with LD. In a field in which males are placed in LD programs in disproportionate numbers, the responsibilities of both authors and publishers are discussed, as their actions may have an impact on female students' rights in accessing appropriate educational services.

Adolescent↗
PubMed1995

Drawing the line: issues of boundary and the homosexual law reform bill campaign in New Zealand (Aotearoa), 1985-86.

The 1985-86 Homosexual Law Reform Bill campaign in Aotearoa (New Zealand) was about 'drawing the line' in several important ways. This paper examines issues of boundary as they arise in the way in which the State contains lesbian and gay populations and hence its response to the pro-Bill movement, the struggle of competing groups over the meaning and progress of the Bill, and some of the difficulties of coalition politics. Rituals, symbols and discourses used throughout the campaign by all sides set the scene for the movement of the legislation through Parliament and the eventual outcome. Issues of power, particularly those concerned with gender, ethnicity, and class, crucially influenced the campaign both inside and outside the lesbian and gay movement. Some reasons why the eventual victory for pro-Bill groups was only partial are suggested.

Civil Rights↗
PubMed2004

Women and AIDS: gender relations and condom use with steady partners.

An educational project on sexuality, STDs, and AIDS was conducted for four years with some 500 women. As a result, changes were observed in HIV-related knowledge and attitudes, but not in risk behaviors for infection. This fact motivated the development of a qualitative study to learn the reasons why women failed to incorporate HIV preventive behaviors into their daily lives. Six focus groups were conducted with women who had participated in the educational project. The analysis was thematic. Women were familiar with HIV transmission routes and preventive measures. They admitted not using condoms due to fear of being suspected of infidelity and because this might lead to separation of the couple. Women reported that relationships with their partners had been difficult because of lack of dialogue and that men always had the final word. Although women had information about AIDS, they did not use preventive measures in steady relationships because they did not wield decision-making power. Gender inequality and fidelity were two significant issues related to the increase in AIDS among women.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Assistant angels: Canadian voluntary aid detachment nurses in the Great War.

Canada's Voluntary Aid Detachment nurses of the Great War have yet to be recognized in Canadian nursing history. This article offers a synopsis of the evidence traced thus far in the search to recover their history, and presents some of the issues that history addresses. Comparisons to the much larger and well-documented British VADs of the era testify to similarities in social origin from among the more privileged Protestant, middle and upper classes from across Canada. Yet significant distinctions have been found in both the academic and employment profile of Canada's VADs. The research addresses conflicts that surrounded issues in the professionalization of nursing, the gendered dimensions of nursing as "women's work," both in peace and war, and tensions deriving from the juxtaposition of both volunteer and career nurses in the hospital environment. The postwar effects of VAD nursing are also addressed, both from the perspective of the women themselves and the emerging Canadian society witnessing the evolution of the "working girl" and the voting woman. While stil incomplete, this research promises to recover a dynamic community of Canadian women, contributing new insights into women's history, medical history, and Canada's history.

Canada↗
PubMed1997

Lessons from the mammography screening controversy: can we improve the debate?

The debate about breast cancer screening for women in their 40s has become so contentious that effective communication and rational discussion on this topic have been compromised. This contentiousness might be defused by understanding the reasons for it. The debate is less about facts than it is about perceptions and values. There is disagreement about how to fairly describe facts about risk and how to avoid misperceptions that may distort assessment of risk. Other sources of disagreement concern the potential harms of screening, the relative roles of physicians and patients in decision making, and how to factor cost into screening decisions. The entire decision-making process has also been highly charged by single-issue advocacy groups and a kind of gender rivalry. Several approaches might help defuse the debate and improve discussion. First, those on both sides of the debate might agree on several things: 1) that the evidence from clinical trials is widely agreed-upon and thus that a main task now is to factor in the values of individual women who are making decisions; 2) that the values of women may differ substantially and that those differences should be respected; 3) that both individuals and the public should be fully and fairly informed about the pros and cons of screening; and 4) that cost-effectiveness should at least be considered during the decision-making process. Lessons from this debate may apply to other medical problems that have small degrees of risk and whose management is strongly debated.

Age Factors↗
PubMed2000

Heart health and gender.

BACKGROUND: Although mortality from cardiovascular diseases is at least as high among women as among men, the notion that such illnesses are gender-specific, afflicting mainly males, continues to influence our present day understanding of heart disease. OBJECTIVE: To compare the average length of stay for men and women admitted to the CCU over a 14-month period. METHOD: All patients admitted to the CCU of a university-affiliated hospital over a 14-month period were included in the study (n = 167). T-test and chi-square were used to analyze means and percentages, respectively. RESULTS: Significantly more men than women gained admittance to the CCU during the time of this study (p < .001). Differences in average length of stay were not statistically significant, however. Similar numbers of men and women underwent cardiac catheterization. CONCLUSIONS: Gender considerations have emerged as a major issue in the diagnosis and treatment of heart disease in women. Although fewer women than men were admitted to the CCU during the study period, similar percentages had invasive interventions performed.

Aged↗
PubMed2003

[High mortality due to infectious diseases and unnatural causes of death among asylum seekers in the Netherlands, 1998-1999].

OBJECTIVE: Description of causes of death among asylum seekers in the Netherlands compared to the Dutch standard population and identification of preventive measures to avoid preventable death. METHODS: An analysis of the causes of death of asylum seekers accommodated in housing facilities of the Central Organ Asylum seekers (COA) for the period 1998-1999 was performed. The primary cause of death was attributed using the International Classification of Diseases (ICD-10) and grouped according to the most important causes of death list issued by Statistics Netherlands. After stratification for gender and age standardised mortality ratios (SMR) were computed. RESULTS: In 82% of the observed deaths amongst asylum seekers a description of the cause and circumstances of death could be obtained. During the 2-year study period 156 asylum seekers died (of which 49 due to an unnatural cause of death and 15 due to infectious diseases). Fourteen stillbirths were registered in an index population of 37,688 in 1998 and 54,110 in 1999. The crude mortality rate was 1.95 per 1000 for male asylum seekers and 1.25 per 1000 for female asylum seekers. Compared to the Dutch standard population, the SMR was 1.23 (95%-CI: 1.01-1.42) for male asylum seekers and 0.85 (0.59-1.11) for female asylum seekers. The elevated mortality in male asylum seekers was due to the high mortality for infectious diseases with an SMR of 4.1 (1.3-6.9) and unnatural death with an SMR of 2.5 (1.7-3.2). More specifically, drowning had an SMR of 11.1 (2.3-20.7), murder and manslaughter 7.3 (2.5-12.0) and suicide 2.8 (1.5-4.1). AIDS accounted for half of the mortality due to infectious diseases. CONCLUSION: In 1998-1999, drowning, murder, manslaughter and suicide contributed significantly to an elevated mortality rate amongst male asylum seekers in the Netherlands. Some of these unnatural deaths could be avoided by implementing preventive measures.

Adolescent↗
PubMedDate not supplied

The potential effectiveness of warning labels on cigarette packages: the perceptions of young adult Canadians.

BACKGROUND: Since 1989 when health warning labels appeared on Canadian cigarette packages, the labels have changed from text only covering less than one quarter of the package to text and graphics covering over half the package. This study examines how Canadians in their 20s feel about the current graphic warning labels and their potential to prevent smoking and encourage quitting. METHODS: Participants between 20 and 24 years of age were part of a 10-year cohort study begun when the group was in Grade 6, with the purpose of examining factors that may affect smoking. Five questions about warning labels were added to the 2002 questionnaire requesting information on perceptions of the labels and their potential impact on smoking behaviours of young adults. One item had been included in previous questionnaires. RESULTS: 32.8% (n = 1267) of the respondents were smokers, with males (35.6%) being more likely to smoke than females (30.4%). Current smokers were less likely than experimental/ex-smokers to believe that warning labels with stronger messages would make people their age less likely to smoke. Female current smokers were more likely to think about quitting. CONCLUSION: Despite the efforts taken in developing the labels, some young adults are skeptical about their effects. Warning labels may have to be modified to target issues that are relevant to young adults; gender differences are important in this modification. Warning labels can offer an additional component to a comprehensive tobacco control program, in that they provide health information.

Adult↗