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PubMed1997

Gender and social differences in adolescent sexuality and reproduction in Nicaragua.

PURPOSE: The aim of this research was to study gender and social differences in adolescent sexuality and reproduction, as reflected in age at first intercourse and age at first pregnancy, as a basis for future interventions in the municipality of León, Nicaragua. METHODS: In a community-based cross-sectional study including 7789 households, all women aged 15-49 years (n = 10,867) were interviewed about socioeconomic, sexual, and reproductive issues. A random subsample of men (n = 388) and women (n = 413) aged 15-49 years was interviewed in more detail about sexual patterns and reproduction. RESULTS: The median age at first intercourse for women and men was 17.8 and 16.2 years, respectively. Women's average latency period to end of first pregnancy was 22 months. There was a significant tendency to start active sexual life later among today's girls aged 15-20 years, compared to the groups 21-27, 28-35, and 36-49 years old. A similar trend was found in age at first pregnancy. These secular trends were not found among men. Age at first pregnancy for current adolescents was lower among those having less formal education. CONCLUSIONS: The short latency period between first sexual intercourse and end of first pregnancy, probably reflecting lack of access to counseling and contraception, is worrying in light of the growing sexually transmitted disease/human immunodeficiency virus threat. The secular trend of later start of reproduction, however, is a positive sign which partly may be an effect of increasing education in the Nicaraguan society.

Adolescent↗
PubMed2001

Aggression in toddlers: associations with parenting and marital relations.

This study examined the relation among parenting factors, marital relations, and toddler aggression. A structured questionnaire was administered to both parents of 254 2-year-olds. The authors used correlation and hierarchical multiple regression analyses to assess the extent to which certain personality traits, drug use, parenting style, and marital conflicts were related to the toddlers' aggressive behavior. Results showed that the maternal child-rearing and parental aggression domains had a direct effect on toddler aggression. The domain of maternal child rearing also served as a mediator for the domains of marital relations, paternal child rearing, parental aggression, and parental drug use. The findings indicated that maternal child-rearing practices, personality attributes, and drug use were more important than paternal attributes in relation to toddler aggression. Implications for prevention among families at risk are discussed.

Aggression↗
PubMed1983

Informed consent and patient decision making: two decades of research.

Patient consent to medical treatment has been a subject of concern within the United States professional communities for over two decades. This paper traces the development of research literature on patient decision making and informed consent to medical treatment in three fields of research: medicine, law and the social sciences. A general model for stages in the development of scientific specialties is applied as a test for the development of informed consent as a specialty interest in each research field. Results indicate a relatively advanced stage of development within medicine and law. Research in the social science disciplines tend to lag behind in terms of cumulative number of publications. In addition, social science research which is potentially relevant to the ethical and policy issues of consent in medical treatment appears to lack a clear programmatic thrust, with little attention given to the policy implications of the work. In contrast, the medical and legal literatures indicate a direct concern with social policy and reflect attempts on the part of physicians and lawyers to influence the policy making process.

Behavioral Research↗
PubMedDate not supplied

Acute treatment of paternal alcohol exposure produces malformations in offspring.

Male rats were intubated only once with either 6, 4, 2, or 0 g/kg alcohol. Food was removed from all animals for several hours after intubation. Males were bred with a single female until sperm was observed in the vaginal smear, for up to a maximum of 7 days after treatment. Females were sacrificed on gestation day 20. There were no significant effects on mating, fecundity, or litter size, but there were significant dose-response increases in "runts" and significant linear associations in the number of malformations in alcohol-sired offspring. A second study using the same methodology found similar results. The results indicate that a single acute treatment with alcohol just prior to breeding may have a significant effect on offspring.

Abnormalities, Drug-Induced↗
PubMed1999

Parent-infant interactions among families with alcoholic fathers.

The purpose of this study was to examine the relationship between fathers' alcoholism and the quality of parent-infant interactions during free play. A related goal was to study the potential mediating or moderating role of comorbid parental psychopathology, such as depression and antisocial behavior, difficult infant temperament, and parental aggression. The sample consisted of 204 families with 12-month-old infants (104 alcoholic and 100 control families), recruited from New York State birth records. Results indicated that fathers' alcoholism was associated with a number of other risk factors (depression, antisocial behavior, and family aggression). Fathers' alcoholism was also associated with more negative father-infant interactions as indicated by lower paternal sensitivity, positive affect, verbalizations, higher negative affect, and lower infant responsiveness among alcoholic fathers. As expected, fathers' depression mediated the relationship between fathers' alcoholism and sensitivity, while maternal depression mediated the association between maternal alcohol problems and maternal sensitivity. Parents' psychopathology did not moderate the association between alcoholism and parent-infant interactions. The results from the present study suggest that the origins of risk for later maladjustment among children of alcoholic fathers are apparent as early as infancy and highlight the role of comorbid parental risk factors.

Adult↗
PubMed2002

Coping in adolescent children of HIV-positive and HIV-negative substance-abusing fathers.

The authors examined coping in the adolescent children of drug-abusing fathers who have, or are at risk for contracting, human immunodeficiency virus (HIV). The ability to cope is an important factor in the adolescent's own risk behaviors, including drug use and associated problems. Each father and his adolescent child were separately administered a structured interview regarding personality, drug use, relationships, coping, and other behaviors. Adolescent adaptive coping was found to be related to greater conventionality, less marijuana use, fewer intra- and interpersonal problems, paternal adaptive coping, and a close father-child bond. Moreover, analysis using a risk factor index indicated an exponential increase in adolescent maladaptive coping with each additional psychosocial risk. Implications for policy and intervention are also discussed.

Adaptation, Psychological↗
PubMed1997

The influence of a big brothers program on the adjustment of boys in single-parent families.

This study is an evaluation of the self-competence, academic performance, behavioral problems, and parent-child relations of boys who had been raised in single-parent families headed by their mothers and who had weekly contact with an adult friend or companion through a midwestern affiliate of the Big Brothers/Big Sisters of America. Results indicated that participation in such a program was not related to changes in the areas investigated. These findings are not consistent with the social support literature suggesting that an adult companion or friend may benefit children in single-parent families. Further study with a larger sample, over a longer time frame, is recommended.

Achievement↗
PubMed2002

Rights not restrictions for learning disabled adults: a response to Spiecker and Steutel.

What follows is a response to an article by Spiecker and Steutel in which they pose the question of whether sex between people with "mental retardation" (sic) is morally permissible and in which they argue that since many such people cannot give "valid consent", the additional consent of caretakers may be required. However, we argue that the term "mental retard" is offensive and that either the UK terminology ("the learning disabled") or the internationally accepted term ("intellectually disabled") are more acceptable. Moreover, we point out that Spiecker and Steutel are mistaken. Many "learning disabled" people can and do give "valid consent". In any case, their question is itself dubious. Why should two learning disabled people who want to have sex together need anyone else's consent? In addition, we briefly address the rights of the learning disabled to the same sexual freedom as others, on the one hand, and to freedom from sexual exploitation on the other hand. Finally, we consider the implications of these issues for moral education. We suggest that carers need to develop empathy and, where necessary, advocacy skills. We point to the existence of training programmes on sexuality and protection issues.

Adult↗
PubMed1998

Patients' preferences for participation in clinical decision making: a review of published surveys.

Models of doctor-patient relations vary between "paternalistic" and "informative." The paternalistic model emphasizes doctors' authority; alternative models allow patients to exercise their rights to autonomy. Published surveys indicate that most patients want to be informed about their diseases, that a proportion of patients want to participate in planning management of their illnesses, and that some patients would rather be completely passive and would avoid any information. The severity of the patients' conditions, and their being older, less well educated, and male are predictors of a preference for the passive role in the doctor-patient relationship, but demographic and situational characteristics explain only 20% or less of the variability in preferences. The only way a physician can gain insight into an individual patient's desire to participate in decision making is through direct enquiry. The ability to communicate health-related information and to determine the patients' desire to participate in medical decisions should be viewed as a basic clinical skill.

Adult↗
PubMed1984

Liberty, beneficence, and involuntary confinement.

My purpose in this paper is to show that current legal criteria for paternalistic involuntary psychiatric confinement of the mentally ill are both too narrow and too broad. I do this by first developing a principle of justified paternalistic interference with adults, which I take to be acceptably protective of individual liberty, but which does not require unnecessary sacrifices of individual welfare. After offering an analysis of current legal criteria for involuntary confinement, I argue that an acceptable theory of paternalistic interference reveals that those criteria (1) exclude some cases where confinement would be morally permissible, and (2) allow paternalistic confinement of many whose detention is not morally justifiable.

Aged↗
PubMed2005

Towards an understanding of nursing as a response to human vulnerability.

It is not unusual for the adjective 'vulnerable' to be applied to those in receipt of nursing practice without making clear what it is that persons thus described are actually vulnerable to. In this paper I argue that the way nursing has adopted the idea of vulnerability tends to imply that some people are in some way invulnerable. This is conceptually unsustainable and renders the idea of the vulnerable patient (almost) meaningless. The paper explores the meaning of vulnerability both in general terms and in the context of nursing practice. It is argued that to be in receipt of nursing is to become, to a greater or lesser extent, more-than-ordinary vulnerable. Thus all patients are more-than-ordinarily vulnerable and this restricts their potential to flourish. Nurses are well placed to contribute to the flourishing of more-than-ordinarily vulnerable persons and my substantive claim is that this 'protective' function is indeed a legitimate and fundamental part of the role of nurses.

Empathy↗
PubMed1990

Let the patients smoke: a defence of a patient privilege.

I examine two kinds of arguments in favour of imposing restrictions on smoking by hospitalised psychiatric patients. First, I look at patient-centered arguments in favour of restrictions. These arguments focus on the benefits that patients will receive if their smoking is stopped or curtailed. Second, I examine arguments that seek to justify restrictions by citing the costs that smokers impose on others. Neither kind of argument justifies any meaningful restrictions on the smoking of hospitalised psychiatric patients.

Behavior Control↗
PubMed1982

Clinical freedom.

Explore the source record for details and available documents.

Choice Behavior↗
PubMed1987

Physicians' non-compliance with patients' refusal of life-sustaining treatment.

Should patients be treated when they have specifically refused treatment? Three competent patients are described with end-stage renal disease who, against the advice of their family, friends and care-givers, refused dialysis. Each was treated and subsequently they acknowledged their satisfaction with the outcome. Guidelines for treating patients when consent is refused are discussed and it is suggested that this is permissible in life-saving situations where the patients' refusal is idiosyncratic and irrational.

Adult↗