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PubMed1996

Adolescent focal theories: age-trends in developmental transitions

Focal theory is considered as a framework for looking at psychosocial and leisure transitions in middle and later adolescence. Although these transitions are examined from a different perspective in the present study, by utilising cross-sectional survey data from a representative sample of three age groups of young Scots (13-14, 15-16 and 17-18 year-olds), the results confirm and extend the general age-trends in relational issues and leisure involvement reported in original studies. Within this overall picture, few gender differences are found in age-related relational transitions, but gender differences are apparent in shifting focuses of leisure involvement with age. Further, the findings suggest a linkage between relational issues in adolescence and leisure contexts, where psychosocial processes are seen to be associated with contextual changes in young people's lives. Focal theory has been criticised for a failure to take true account of the social circumstances, constraints and contexts affecting adolescent development, but in the present study surprisingly few differences are found with respect to the young person's social class of family background, for example, with age-trends in developmental transitions similar for all social groups. By contrast, in later adolescence aspects of the young person's own socio-economic position, rather than that of their family background, are clearly linked to both relational issues and leisure involvement, for example, creating a disrupting effect on those young people who are currently unemployed or non-employed at this age.

Journal Article↗
PubMed1997

Psychosocial concerns and health-compromising behaviors among overweight and nonoverweight adolescents.

OBJECTIVE: To compare weight-specific and global psychosocial concerns and health-compromising behaviors among overweight and nonoverweight youth across gender and ethnicity. METHODS: A cross-sectional school-based survey of 31,122 adolescents in grades 7 to 12. Based on self-reported heights and weights, respondents were categorized as nonoverweight (body mass index (BMI) < 85th percentile), moderately overweight (85th percentile < BMI < 95th percentile), or severely overweight (BMI > 95th percentile). RESULTS: Global psychosocial concerns, such as emotional well-being, suicidal ideation, future job concerns, and peer concerns, did not differ greatly between nonoverweight, moderately overweight, and severely overweight adolescents. Substance abuse behaviors were equally or less prevalent among the overweight group. Overweight girls were significantly less likely to consume alcohol, whereas overweight boys were at lower risk for marijuana use. In contrast, overweight youth were more likely to perceive their health as only fair or poor and were more likely to express weight-specific concerns and engage in behaviors such as chronic dieting and binge eating than nonoverweight youth. Overweight American Indian girls perceived their physical health more positively than nonoverweight American Indian girls. Strong associations were found between overweight status and chronic dieting among African American boys and girls. CONCLUSIONS: Nutritional counseling and educational programs need to address the weight-specific concerns and behaviors of overweight adolescents. However, assumptions regarding global psychosocial concerns and health-compromising behaviors among overweight adolescents of different genders and ethnicities should be avoided. These broad issues need to be explored in more depth at both the research and intervention levels.

Adolescent↗
PubMed1995

Worldly and workday worries: contemporary concerns of children and young adolescents.

Top-of-the-head worries were elicited young people, grade 4 to 8, both before and after they completed quantitative risk assessments of specific health and environmental problems. Results revealed that many students carry a substantial worry burden that includes not only personal matters such as grades and social relations, but also concerns about death and about global issues such as homelessness and environmental degradation. The gender and grade differences that emerged were consistent with a developmental extension from self to societal perspectives. Differences in worry profiles from before to after the risk assessment interviews revealed some impact of recent exposure, as illustrated by a pre-post increase from 7% to 30% in students spontaneously expressing AIDS-related concerns. Implications of the breadth and severity of young people's concerns are discussed, as are the ambiguities inherent in standard assessment approaches.

Achievement↗
PubMed1998

A case for the usefulness of laboratory social stressors.

Although laboratory stress research is a popular and vibrant area of research activity, there is surprisingly little evidence that laboratory stress models are clinically useful (i.e. that they can explain and predict the development of disease). This article summarizes evidence that the usefulness of lab stress research can be improved with the use of social stressors. Two lines of evidence are presented in support of this argument: (a) studies comparing physiological reactivity to different lab stressors with ambulatory activity, and (b) a meta-analysis of investigations of cortisol responses to laboratory stressors. Further issues of importance in understanding social stressors are gender differences and the vulnerability (i.e. weak reliability) of social stressor impact to relatively small changes in the experimental protocol itself.

Cardiovascular Physiological Phenomena↗
PubMed2007

Cultural awareness through medical student and refugee patient encounters.

PURPOSE: This paper presents findings from a qualitative investigation of cultural awareness that medical students developed in the context of providing medical care to refugees. Our evaluation question was: What kinds of cultural awareness and communication lessons do medical students derive from clinical encounters with refugee patients? METHODS: Thirty-eight semi-structured interviews were conducted to debrief a sample of 27 medical students. A multidisciplinary research team analyzed the debriefing texts following an interpretive "immersion-crystallization" approach. RESULTS: Three domains in cultural awareness training encompassed 13 key lessons or themes. Students reported enhanced awareness about the use of interpretation services and cross-cultural communication. A second set of lessons reflected awareness of the refugees' cultural background, and a third learning component involved experiences of cultural humility. The refugee plight prompted reflection on the students' own culture, and validated the rationale for empathetic care and patient empowerment. CONCLUSION: As medical school curricula incorporate more cultural diversity training, a patient-based learning approach with selected 'hands-on' experiences will create opportunities for students to increase their cultural sensitivity and competency. This program's experiential model indicates that after refugee medical encounters, these beginning medical students reported greater awareness of communication issues, and sensitivity toward religious values, family patterns, gender roles and ethnomedical treatments. It will be important to test these kinds of preceptor/apprenticeship models of cultural sensitivity training at later stages of medical training; in order to assess long-term effects.

Communication↗
PubMed1994

Perceptions of mothers' and fathers' abusive and supportive behaviors.

Young adults' perceptions of parenting behaviors were explored, specifically with regard to the issue of how perceptions may be affected by gender of parent, child, or observer. Ratings of psychologically (emotionally), physically, and sexually abusive behaviors and ratings of love/support, promotion of independence, and positive modeling/fairness were obtained for mothers and fathers as well as daughters and sons. When father was the referent, female subjects rated the behaviors as more emotionally, physically, and sexually abusive than male subjects did. When mother was the referent, gender of subject and gender of child interacted, with female subjects rating the behaviors as more abusive when done to sons than male subjects did. Male and female subjects agreed that behaviors representing love/support and fairness were highly supportive when done by fathers. When done by mothers, female subjects rated love/support behaviors as more supportive for sons than male subjects did. Results indicated that gender of parent, child, and observer may affect young adults' perceptions of parental abusiveness and supportiveness.

Adult↗
PubMed2004

Deformable model with surface registration for hippocampal shape deformity analysis in schizophrenia.

Changes to the hippocampal structure have been reported as consistent structural abnormalities in schizophrenic patients and have been related to the learning and memory deficits in such patients. Although many magnetic resonance (MR) imaging studies have focused on the hippocampal volume, local structural changes were difficult to discriminate from normal neuroanatomical variations. 3D shape deformation analysis of the brain structure may reflect localized schizophrenic abnormalities. A deformable model, evolved from the ellipsoid to hippocampal surface, with 2562 vertexes, was developed to analyze the left and right hippocampus shapes in 22 schizophrenic patients and 22 healthy age and gender matched controls. One of the most critical issues in the shape analysis is the determination of homologous points between two objects. To determine more accurate corresponding points, an alignment procedure, consisting of coarse and fine steps, following a deformation process, was applied. The performance of the alignment process was tested using artificial data, to get the alignment error to within 3 degrees for each angle. A volume analysis indicated the hippocampal volume to be bilaterally reduced in schizophrenic patients compared to the normal controls, with a shape analysis showing a deformity pattern of the hippocampal surface. Bilateral inward deformities in the anterior and posterior hippocampus and a unilateral outward deformity in the right anterior hippocampus were observed, respectively.

Adult↗
PubMed2005

Development of experimental designs for atherosclerosis studies in mice.

The mouse has become the de facto model for the majority of atherosclerosis studies. Studies involving the quantification of lesions in mouse models of the disease represent the basis of our evolving concepts on the biochemical and cellular mechanisms underlying the atherogenic process. Many issues of experimental design, including specific model, strain, gender, atherogenic stimulus, duration of study, group size, and statistical analysis may influence the outcome and interpretation of atherosclerosis studies. The selection of vascular bed in which to quantify atherosclerotic lesion size could also impact the interpretation of results. Early studies quantified atherosclerotic lesion size in either specific regions or all of the aortic sinus. Measurement of atherosclerosis throughout the aortic intimal surface has become a common mode for defining lesion size. It is likely that other vascular regions will be increasingly used. In addition to size, there is an increased emphasis on identifying and quantifying the cellular and chemical composition of atherosclerotic lesions.

Animals↗
PubMed2003

Patient preference for physician discussion and practice of spirituality.

OBJECTIVE: To determine patient preferences for addressing religion and spirituality in the medical encounter. DESIGN: Multicenter survey verbally administered by trained research assistants. Survey items included questions on demographics, health status, health care utilization, functional status, spiritual well-being, and patient preference for religious/spiritual involvement in their own medical encounters and in hypothetical medical situations. SETTING: Primary care clinics of 6 academic medical centers in 3 states (NC, Fla, Vt). PATIENTS/PARTICIPANTS: Patients 18 years of age and older who were systematically selected from the waiting rooms of their primary care physicians. MEASUREMENTS AND MAIN RESULTS: Four hundred fifty-six patients participated in the study. One third of patients wanted to be asked about their religious beliefs during a routine office visit. Two thirds felt that physicians should be aware of their religious or spiritual beliefs. Patient agreement with physician spiritual interaction increased strongly with the severity of the illness setting, with 19% patient agreement with physician prayer in a routine office visit, 29% agreement in a hospitalized setting, and 50% agreement in a near-death scenario (P <.001). Patient interest in religious or spiritual interaction decreased when the intensity of the interaction moved from a simple discussion of spiritual issues (33% agree) to physician silent prayer (28% agree) to physician prayer with a patient (19% agree; P <.001). Ten percent of patients were willing to give up time spent on medical issues in an office visit setting to discuss religious/spiritual issues with their physician. After controlling for age, gender, marital status, education, spirituality score, and health care utilization, African-American subjects were more likely to accept this time trade-off (odds ratio, 4.9; confidence interval, 2.1 to 11.7). CONCLUSION: Physicians should be aware that a substantial minority of patients desire spiritual interaction in routine office visits. When asked about specific prayer behaviors across a range of clinical scenarios, patient desire for spiritual interaction increased with increasing severity of illness setting and decreased when referring to more-intense spiritual interactions. For most patients, the routine office visit may not be the optimal setting for a physician-patient spiritual dialog.

Black or African American↗
PubMed2001

An examination of several characteristics that affect the prediction of OSPL90 in hearing aids.

OBJECTIVE: Investigators at the National Acoustic Laboratories have provided a theoretical derivation and experimental validation of a formula for setting the maximum output of hearing aids (Dillon & Storey, 1998; Storey, Dillon, Yeend, & Wigney, 1998). Given that measurement of discomfort levels for setting maximum output can be both time-consuming and of questionable reliability, the use of a prescriptive formula warrants consideration. In this article, an extensive data base was considered and issues of normal hearing, clinical protocol, age and gender were investigated in an effort to further determine optimal maximum output settings. DESIGN: Data were gathered from five previous investigations, for a total of 433 subjects (total ears = 710). Threshold of discomfort (TD) measures were obtained using one of two adaptations of the Ascending Method of Limits, one with category anchors and one without. RESULTS: Subjects with normal hearing had significantly lower TDs than subjects with hearing loss. A different regression line for measured TDs as a function of hearing level was noted for subjects whose hearing threshold levels fell between 20 and 60 dB HL and those with thresholds above 60 dB HL. When all effects (hearing level, method, age and gender) were considered in a single predictive model for the two threshold groups, only method and threshold were significant predictors of TD. However, for the subjects with thresholds between 20 and 60 dB HL, less than 4% of the variance in TD measures could be accounted for by those factors. For subjects with threshold above 60 dB HL, 22% of the variance in TD measures could be accounted for by those variables. CONCLUSIONS: For both groups of subjects (20 to 60 dB HL and above 60 dB HL) methodology and hearing thresholds are significant predictors of discomfort levels. Age and gender are not. Given the small variance accounted for by any of these factors, measures of discomfort using standardized methodologies seem warranted.

Acoustic Stimulation↗
PubMed2006

The analysis of the homoerotic and the pursuit of meaning.

This paper explores the dynamic tension between an evolving collective phenomenon and the nature of analytic process. Specifically, the focus will be erotic experiences which acquire a meaning through the culture at large, a meaning that may not be supportable when that material is subjected to psychological analysis. This stimulates a conflict between the symbolic attitude and the cultural perspective of the time. While the struggle between the individual and collective consciousness always emerges in analysis, the subject of same-gender sexual relations has become such a controversial and divisive issue in the current political environment that views toward homosexuality demand powerful allegiances and identification with either historic or contemporary ideas. People now identify as 'gay' and tend to see themselves as something akin to a race or perhaps alternative gender. Sexuality and relationship between same gendered people tends to be viewed through the lens of civil rights and the undeniable need for social equality. In this far-reaching and expanding collective phenomenon, psychology, in its support of human rights and accommodation to emerging trends, may be diminished in its capacity to pursue the meaning inherent in these human experiences. The position developed in this paper is that psychological experience, whether in the imaginal realm, dreams or personal consciousness, must be available for full analysis. Clinical experience and dreams are used to amplify this challenge to dynamic analytic practice.

Civil Rights↗
PubMed1995

The medical hierarchy and perceived influence on technical and ethical decisions.

OBJECTIVE: To investigate the influence of hierarchial position and perceived influence on ethical and technical decisions. DESIGN: The study was conducted as a postal questionnaire survey. SUBJECTS: A random sample of 329 Danish physicians working at departments of internal medicine and related subspecialties. Of these, 270 (82%) returned a completed questionnaire. MAIN OUTCOME MEASURE: Self-reported perceived influence in discussions about technical and ethical issues in connection with decisions to terminate treatment for patients with terminal malignant illness. RESULTS: The odds ratio for perceived influence between consultants and house officers is 14.9 for ethical issues, 44.9 for technical issues, and 652.3 for questions concerning departmental policy. Gender plays no role, when one controls for hierarchial position. CONCLUSIONS: Hierarchial position is the major determinant of perceived influence on technical and ethical decisions. Position seem to play a larger role in technical than in ethical decisions.

Decision Making↗
PubMed2002

Hospital ethics committees in Israel: structure, function and heterogeneity in the setting of statutory ethics committees.

OBJECTIVES: Hospital ethics committees increasingly affect medical care worldwide, yet there has been little evaluation of these bodies. Israel has the distinction of having ethics committees legally required by a Patients' Rights Act. We studied the development of ethics committees in this legal environment. DESIGN: Cross-sectional national survey of general hospitals to identify all ethics committees and interview of ethics committee chairpersons. SETTING: Israel five years after the passage of the Patients' Rights Act. MAIN MEASUREMENTS: Patients' rights and informal ethics committee structure and function. RESULTS: One-third of general hospitals have an ethics committee, with committees concentrated in larger facilities. Hospitals without committees tended to lack any structure to handle ethics issues. Committees tend to be interdisciplinary and gender-mixed but ethnic mix was poor. Confidentiality is the rule, however, legal liability is a concern. One-third of patients' rights ethics committees never convened and most committees had considered fewer than ten consults. Access to the consultation process and the consultation process itself varied substantially across committees. Some patients' rights ethics committees attempted to solve cases, others only rendered decisions. Informal committees often refused to consider cases within Patients' Rights Act jurisdiction. CONCLUSIONS: Despite statutory requirement, many Israeli patients and clinicians do not have access to ethics committees. The scant volume of cases shows serious discrepancies between practice and Patients' Rights Act regulations, suggesting the need for education or revision of the law. Heterogeneity in committee function demonstrates need for substantial improvement.

Confidentiality↗
PubMed2005

Immigrant Latinas' conceptualizations of intimate partner violence.

This study was a qualitative investigation of the conceptualization of intimate partner violence (IPV) among immigrant Latinas. The research approach used was naturalistic inquiry: conducting research maintaining minimal interference with the phenomenon of interest. Findings revealed that the immigrant Latinas in this study were aware of the poor quality of intimate relationships in their community, were knowledgeable about IPV, and understood that IPV is an extensive problem in the immigrant Latino community. In addition, the women recognized gender disparities and other ecological factors as central issues affecting their intimate relationships and leading to IPV.

Adult↗
PubMed2004

Teaching the testicular exam: a model curriculum from "A" to "Zack".

BACKGROUND AND OBJECTIVES: The testicular exam was not explicitly taught at our medical schools before 2002. In this article, we explore different phases of curriculum development, implementation, and evaluation of a method for teaching the testicular exam. METHODS: Medical students participated in surveys and focus groups, and male patients participated in focus groups. From the results of the focus groups, we developed a comprehensive testicular exam module that includes (1) a PowerPoint lecture, (2) a video, (3) reading materials, and (4) an artificial male model ("Zack"). These materials were then incorporated into family medicine clerkships. Students and faculty have evaluated the project. RESULTS: Initially, students expressed discomfort discussing sexual issues with patients, especially those of the opposite gender, and knew little about testicular cancer. Male patients had limited knowledge of the testicular self-exam and felt that their physical exam training had not been ideal. Faculty and students agreed that a lecture on the testicular exam and practice with Zack were useful in improving their exam skills, while the video and readings were less so. CONCLUSIONS: To address curricular deficits, a self-contained module on the testicular exam has been successfully incorporated into family medicine clerkships at two different medical schools. This module is easily adaptable to other settings and institutions.

Adult↗
PubMed1986

The tilted family.

This paper is a report on clinical observations of a particular family constellation which has seldom been discussed in terms of its theoretical and therapeutic importance. We outline the possible effects on families of having same-gender children. Four case examples are given to highlight how this issue can be of value in assessment and treatment.

Adolescent↗
PubMed2003

Growth deficits and attention-deficit/hyperactivity disorder revisited: impact of gender, development, and treatment.

OBJECTIVE: Although the relationship between putative growth deficits and attention-deficit/hyperactivity disorder (ADHD) has been examined in boys, this issue has not been evaluated in girls. METHODS: Height and weight were examined in 124 female ADHD children and 116 female controls using age and parental height corrections, attending to issues of pubertal stage and treatment. Also, we examined the interaction between ADHD status and gender on growth outcomes using data from 124 ADHD and 109 control males. RESULTS: The ADHD-growth association was not moderated by gender. No deficits in age-adjusted height or age and height-adjusted weight were detected in ADHD girls. Also, we found no association between growth measurements and psychotropic treatment, malnutrition, short stature, pubertal development, family history of ADHD, or psychiatric comorbidity, except for major depression: ADHD girls with major depression were on average 7.6 kg heavier than ADHD girls without depression, adjusting for age and height. CONCLUSIONS: No growth deficits appear to be associated with ADHD or its treatment in females. These findings add to a growing literature supporting the notion that stimulant treatment does not have an adverse impact on ADHD children's growth and development.

Adolescent↗
PubMed2006

Staff gender ratio and aggression in a forensic psychiatric hospital.

Gender balance in acute psychiatric inpatient units remains a contentious issue. In terms of maintaining staff and patient safety, 'balance' is often considered by ensuring there are 'sufficient' male nurses present on each shift. In an ongoing programme of research into aggression, the authors investigated reported incidents of patient aggression and examined the gender ratio on each shift over a 6-month period. Contrary to the popular notion that a particular gender ratio might have some relationship with the likelihood of aggressive incidents, there was no statistically significant difference in the proportion of male staff working on the shifts when there was an aggressive incident compared with the shifts when there was no aggressive incident. Further, when an incident did occur, the severity of the incident bore no relationship with the proportion of male staff working on the shift. Nor did the gender of the shift leader have an impact on the decision to seclude the patient or the likelihood of completing an incident form following an aggressive incident. Staff confidence in managing aggression may be influenced by the presence of male staff. Further, aspects of prevention and management may be influenced by staff gender. However, results suggest there is no evidence that the frequency or severity of aggression is influenced by staff gender ratio.

Acute Disease↗