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PubMed1992

Feminist directions in medical ethics.

I explore some new directions - suggested by feminism - for medical ethics and for philosophical ethics generally. Moral philosophers need to confront two issues. The first is deciding which moral issues merit attention. Questions which incorporate the perspectives of women need to be posed - e.g., about the unequal treatment of women in health care, about the roles of physician and nurse, and about relationship issues other than power struggles. "Crisis issues" currently dominate medical ethics, to the neglect of what I call "housekeeping issues." The second issue is how philosophical moral debates are conducted, especially how ulterior motives influence our beliefs and arguments. Both what we select - and neglect - to study as well as the "games" we play may be sending a message as loud as the words we do speak on ethics.

Bioethical Issues↗
PubMed1990

Community recognition of objective and subjective characteristics of depression.

Assessed knowledge of depression in a random sample of 527 community-living adults. Vignettes were presented which described a young or old protagonist with depressive symptoms. Respondents were asked to identify potential problems and possible solutions. A depression information measure followed. Results indicated that community residents were aware of many objective features of depression although they identified less information about treatment issues. Older respondents were least informed. Although there were no gender differences in objective knowledge, men were less likely to mention depression with regard to the vignettes. Suggestions for implementing more effective community interventions are discussed.

Adaptation, Psychological↗
PubMed2002

A Swedish survey of young people's views on organ donation and transplantation.

The aim of this study is to explore young people's attitudes, beliefs, and knowledge on organ donation and transplantation. A survey was conducted among 1,447 students aged 15-18 years in four urban areas in Sweden. Although students looked upon organ transplantation favorably, only 50% were willing to donate their own organs, and only 20% the organs of their parents. Concerning organ donation, 75% of the students expressed some discomfort. There were significant gender differences. About 70% of the students indicated that transplantation issues should be included in the school curriculum. It is concluded that teenagers feel irresolution and discomfort regarding organ donation after death, but concurrently see organ transplantation as a highly valued service. One way that this mental conflict can be resolved is through education. Educational programs in school must address this ambivalence and both mediate facts and help students to work through the fear and discomfort associated with organ donation.

Adolescent↗
PubMed2004

Regulation of organic cation transport.

Transport of organic cations (OC) is important for the recycling of endogenous OC and also a necessary step for detoxification of exogenous OC in the body. Even though the identification and characterisation of numerous OC transporters in recent years has allowed the elucidation of molecular mechanisms underlying OC transport, elucidation of the regulation of this transport is just beginning. This review summarises the general properties of OC transport and then analyses the literature on the regulation of these processes. Studies on short- and long-term regulation of OC transport are considered separately. Important aspects of short-term regulation have been clarified and the regulatory pathways of several OC transporters have been characterised. Short-term regulation appears to be transporter subtype-, tissue- and species-dependent and to involve transporter phosphorylation. Transporter phosphorylation may alter the affinity for substrates or/and expression on the plasma membrane. Even though several studies have shown long-term regulation of OC transport, the pathophysiological meaning of these changes are not well understood. In this case, regulation seems to be subtype-, tissue- and gender-specific. Further research is necessary to clarify this important issue of regulation of OC transport.

Animals↗
PubMed2001

Medical student competence in eliciting a history for "chronic fatigue".

PURPOSE: We report an observational study of medical students' abilities in taking a complex history for which sleep disorders is one of several possible conditions. METHODS: Students are observed taking a focused history from a simulated patient whose chief complaint is "I am tired. I cannot get anything done." Nine groups of students (n = 360) completing the internal medicine core-clerkship were evaluated by one of three examiners. Students received full, partial, or no credit for each item on a uniform behavioral checklist, which included prompts for common medical and psychiatric disorders associated with chronic fatigue. RESULTS: Observed means were lowest for items pertaining to sleep behaviors and head trauma. Fewer than half of the students inquired about whether or not the person had difficulty falling asleep at night, family history of sleep apnea, and frequency and length of naps. In contrast, the majority of students inquired about heart disease, metabolic disorders, the use of illicit drugs, alcohol consumption, and the taking of medications. Examiners accounted for a significant source of variance in scores; yet the station discriminated among top and bottom students as measured by the Objective Structured Clinical Examination (OSCE) overall. No statistically significant differences were observed on the basis of clerkship site, primary care versus traditional-track students, time of year, or gender. CONCLUSION: A majority of students do not adequately cover issues relevant to sleep in contrast to other associated disorders when taking a focused history for chronic fatigue.

Fatigue Syndrome, Chronic↗
PubMed2006

Outpatient drug abuse treatment for Hispanic adolescents.

The objective of this article is to review the state of the science in evidence-based drug abuse treatments for Hispanic adolescents, highlight scientific opportunities, and offer recommendations to further the field of drug abuse treatment for this population. The article is divided into seven sections: boundaries for this review, drug abuse and associated problems, behavioral treatment, cultural issues in hispanic adolescent behavioral drug abuse treatment, pharmacological treatment, gender differences in treatment, and scientific opportunities/recommendations. Although only one treatment approach, Brief Strategic Family Therapy, has been empirically shown to be efficacious in treating Hispanic adolescent drug abusers, with some modifications other treatments may also have the potential to be efficacious with Hispanic adolescents. Family-based approaches, which typically appear to be most efficacious with adolescents in general, may also have the greatest potential to treat drug abuse in Hispanic adolescents.

Adolescent↗
PubMed2006

Asian/Pacific Islander youth violence prevention center: interpersonal violence and deviant behaviors among youth in Hawai'i.

PURPOSE: This study investigates the prevalence rates of violent and deviant behaviors among a sample of Filipino, Hawaiian, Japanese, and Samoan public high school students residing in Hawai'i, and is the first relatively large-scale study of its kind regarding a disaggregated sample of Asian American and Pacific Islander (AAPI) youth. Filipino, Hawaiian, and Samoan adolescents were the chosen ethnic groups for this study's focus due to their over-representation in Hawai'i's juvenile justice system. METHODS: Data for this study were gathered collaboratively by researchers, community groups, and school officials who agreed that youth violence was a community concern worthy of deeper understanding and community response. The study's process included three phases: a focus group consultation phase, field-testing, and the final risk and protective factor study. For the final study, 326 randomly selected students representing three Hawai'i public high schools were surveyed on a one-on-one basis.A smaller sample of Japanese students was also included in the study, serving as a control group. RESULTS: Findings illustrate the importance of disaggregating specific ethnic and gender groups within the AAPI ethnic category when examining adolescent issues. As examples, Samoan youth reported significantly higher rates of violence than other ethnic groups surveyed, and Hawaiian girls reported higher rates of substance use than Hawaiian boys, which was not commensurate with other ethnic groups. Filipino, Hawaiian, and Samoan youth all reported significantly higher rates than Japanese on overall deviant behavior. CONCLUSIONS: Implications for further research and community development include enhancing minority youths' bicultural self-efficacy.

Adolescent↗
PubMedDate not supplied

Status of women and infants in complex humanitarian emergencies.

Women and children bear the greatest burden in the midst of war and long-term disasters. Complex humanitarian emergencies are characterized by social disruption, armed conflict, population displacement, collapse of public health infrastructure, and food shortages. Humanitarian assistance for refugees and internally displaced populations requires particular attention to the common issues affecting morbidity and mortality in women and infants. Gender-based violence and reproductive health concerns are discussed within the context of populations affected by conflict and forced migration. Recommendations for midwives and women's health care providers engaging in care for women and children in complex humanitarian emergencies are discussed.

Developing Countries↗
PubMed2006

Kant on epigenesis, monogenesis and human nature: the biological premises of anthropology.

The aim of this paper is to show that for Kant, a combination of epigenesis and monogenesis is the condition of possibility of anthropology as he conceives of it and that moreover, this has crucial implications for the biological dimension of his account of human nature. More precisely, I begin by arguing that Kant's conception of mankind as a natural species is based on two premises: firstly the biological unity of the human species (monogenesis of the human races); and secondly the existence of 'seeds' which may or may not develop depending on the environment (epigenesis of human natural predispositions). I then turn to Kant's account of man's natural predispositions and show that far from being limited to the issue of races, it encompasses unexpected human features such as gender, temperaments and nations. These predispositions, I argue, are means to the realisation of Nature's overall purpose for the human species. This allows me to conclude that man's biological determinism leads to the species' preservation, cultivation and civilisation.

Anthropology↗
PubMed1997

Domestic violence and mental health: correlates and conundrums within and across cultures.

Gender-based violence, only recently emerging as a pervasive global issue, contributes significantly to preventable morbidity and mortality for women across diverse cultures. Existing documentation suggests that profound physical and psychological sequelae are endemic following intimate partner violence. The presentation of domestic violence is often culture specific. A new lexicon, prompted by the expansion of human rights analysis, describes particular threats to local women including dowry deaths, honor murder, saiti, and disproportional exposure to HIV/AIDS as well as globally generic perils including abuse, battering, marital rape, and murder. While still fragmentary, accruing data reveal strengthening associations between domestic violence and mental health. Depression, stress-related syndromes, chemical dependency and substance (ab)use, and suicide are consequences observed in the context of violence in women's lives. Emerging social, legal, medical, and educational strategies, often culture specific, offer novel local models to promote social change beginning with raising the status of women. The ubiquity, gravity, and variability of domestic violence across cultures compel additional research to promote the recognition, intervention, and prevention of domestic violence that are both locally specific and internationally instructive.

Cross-Cultural Comparison↗
PubMedDate not supplied

Negotiation of HIV preventive behaviors in divorced and separated women reentering the sexual arena.

The purpose of this study was to understand divorced and separated women's experience of negotiating human immunodeficiency virus (HIV) preventive behaviors when resuming sexual activity following long-term monogamous relationships. A little-studied but large group, these women are at risk for sexually transmitted diseases, have low rates of protective behaviors, and have not been targeted for prevention education. Seven women entering a sexual milieu altered by the presence of HIV after at least a 10-year period of monogamy comprised the sample. A descriptive phenomenologic methodology incorporating Colaizzi's method for data analysis revealed four themes: (a) keeping the magic, (b) Am I an adolescent or an adult? (c) holding on to self, and (d) gender perspectives. These women's words help to illuminate their issues regarding HIV prevention, guiding further nursing research and HIV preventive educational interventions.

Adult↗
PubMed1997

Norms for parental ratings on Conners' Abbreviated Parent-Teacher Questionnaire: implications for the design of behavioral rating inventories and analyses of data derived from them.

Despite the wide usage of Conners' 10-item Abbreviated Parent-Teacher Questionnaire (APTQ), normative data for parental ratings on the APTQ are rare. Moreover, its psychometric properties as a "stand alone" behavioral rating instrument have yet to be examined in detail. Using data from parental ratings for 6,841 children aged 5 to 14 years, this paper reports the psychometric properties of the APTQ and provides normative and prevalence estimates for four age cohorts (5 to 6, 7 to 8, 9 to 11, and 12 to 14 years) by gender. In presenting the findings, the paper highlights key methodological issues endemic to the design of behavioral rating inventories like the APTQ and the analysis of data derived from them. These issues are illustrated and discussed in terms of their implications for the measurement and determination of prevalence estimates of problem behaviors in child psychology and child psychiatry. The need to revise the design, content, and response formats of child behavior rating inventories is stressed.

Adolescent↗
PubMed2003

Root canal treatment performed by Flemish dentists. Part 1. Cleaning and shaping.

AIM: To gather information on root canal treatment carried out by dentists working in Flanders (Belgium). METHODOLOGY: A questionnaire was handed to 312 dentists attending peer review sessions organized by the Flemish Universities. Basic information (age, gender, year of graduation, practice profile) and information on various issues relating to the cleaning and shaping of root canals was collected. RESULTS: A total of 310 questionnaires were returned. The majority (85.7%) of respondents categorized themselves as general practitioners; 25.7% mentioned a clinical interest or speciality in practice. Most practitioners (64.5%) did not use rubber dam routinely during root canal treatment and performed treatment over two visits irrespective of the number of root canals. The majority of respondents (82.4%) used sodium hypochlorite as an irrigant, but 10.6% did not know the concentration they used; EDTA was used by 61.6%. The vast majority exposed a radiograph with an instrument of known length in situ to gauge the working length; only 3.6% relied on tactile sense; electronic root canal length determination was seldom used. Amongst the root canal instruments, K-files were used solely or in combination with other instruments by 60.3% of the respondents, reamers were used solely or in combination with other instruments by 55.4%. The stepback technique was used by 31.2% of the participants, a combination of stepdown and stepback by 26.4%, a reaming technique by 26.1% and the step-down technique by 14.7%. The majority were familiar with mechanical root canal Instruments. Almost half of the practitioners believed their preparation technique could be improved: only 1.3% felt that their procedures were poor. CONCLUSIONS: The results of this study indicate that the theoretical knowledge of dentists working in Flanders is good. However, the use of rubber dam remained low, half believed their preparation technique could be improved.

Belgium↗
PubMed1996

Parents' perceptions of children's worries in a changing world.

The nature and intensity of worries that preadolescent children experience and the extent to which parents are aware of their children's concerns were examined. Questionnaires with three subscales (Physical Harm, Daily Life Matters, and Global Issues) were filled out by 89 6th graders and their parents. Parents underestimated the overall degree to which children worry, and they tended to believe that their children worried most about daily life matters, such as grades and popularity; children were in fact least worried about daily life matters and most worried about global issues, such as pollution and starvation. Both child and parent gender differences were found.

Adaptation, Psychological↗
PubMed2006

Student diversity at Erasmus Medical Centre Rotterdam: does it make any difference?

In an ethnically diverse society cultural competence is indispensable for medical doctors. At present 10% of the Dutch population are first- or second-generation non-Western immigrants. With 8% Western and 18% non-Western immigrants, originating from 30 different countries, the 2001 Rotterdam first-year students highly out-rated the national average of immigrant medical students. Diverse student populations may enhance students' cultural competence but can also generate conflicts or even racism. This was the first Dutch study on expectations and experiences of medical students related to their ethnic and religious background. In December 2001 all first-year students were approached with an anonymous questionnaire, including statements on the expected influence of their culture and religion on their medical education (rated on a 1-5 Likert scale). In spring 2003 17 students from the same cohort, 8 immigrants and 9 ethnic Dutch, were interviewed extensively on their study experiences in a diverse student population. In 2001 the response rate was 90% (277/308), female-male ratio 63% (175/102). Non-Western immigrants expected for their medical education more benefits from their culture but also more obstacles than ethnic Dutch (p < or = 0.005). Protestants and Muslims expected more obstacles than the non-religious and Catholics (p < or = 0.05). In the interviews three main issues emerged: peer training in physical examination in mixed-gender groups, lack of attention to student diversity during education, and demand for education in cross-cultural medicine. Three incidents of perceived discrimination were reported. The ethnic Dutch students interviewed did not socialize much with immigrants, nor did students of both groups learn much from one another. Most students favoured mixed study groups. The diversity of the population does not seem to have caused serious problems, nor has it offered educational benefits. The challenge for educators is to provide systematic education in cultural competence and cross-cultural medicine, in which students and educators indeed practise communication across cultural borders.

Academic Medical Centers↗
PubMed2005

Obstacles to condom use among secondary school students in Maputo city, Mozambique.

This study explores how urban youth in Mozambique perceive their sexual behaviour and identifies the factors that hinder them from having safer sex in the context of HIV/AIDS, with special emphasis on the condom use. Data was collected form high school students in Maputo, Mozambique. Using a combination of focus group discussions, interviews and informal conversations, it was possible to identify that one major obstacle to the use of condoms was young people's belief that they did not have to use condoms in steady relationships built on love and trust. Trust and love provide a sense of immunity to infection. Such a perception is reinforced, it is argued, by previous HIV/AIDS campaigns in Mozambique that have advocated the use of condoms only with 'occasional sexual partners'. Students' understandings of pleasure, lack of accurate information, lack of sex education at home and at school, and gender inequalities further contribute to making condom use a difficult issue. There should be a change in focus in condom campaigns. Efforts should also be made to encourage young people to 'emotionally invest' in their health by using condoms.

Adolescent↗
PubMed2002

Pain reports by older hospice cancer patients and family caregivers: the role of cognitive functioning.

PURPOSE: Prior research in nursing homes has shown that cognitive impairment may reduce self-reported pain, but this relation has not been systematically explored among hospice patients. The assessment and treatment of pain is a primary goal of hospice care, and both disease processes and the use of opioid analgesics may lead to cognitive impairment among hospice patients. However, little is known about how cognitive functioning may impact the self-report of pain or the report of care recipient pain by family caregivers. DESIGN AND METHODS: We explored the associations between pain, cognitive functioning, and gender among cancer patients and their family caregivers (N = 176 dyads) during in-home hospice care. This was a cross-sectional, correlational study. RESULTS: Contrary to expectation, care recipients with cognitive impairment reported more intense pain than care recipients with intact cognitive functioning. However, cognitive impairment among care recipients had no impact on the pain report of family caregivers. Care recipient cognitive impairment was related to greater discrepancy in the pain reports of caregivers and care recipients. No gender differences in pain intensity report were found. IMPLICATIONS: Measurement issues and implications for assessing self-reported pain among hospice cancer patients with impaired cognitive functioning and the report of care recipient pain by family caregivers are discussed. Specifically, hospice staff must educate family caregivers regarding the potential impact of care recipient cognitive impairment on pain reports in order to facilitate accurate pain assessment and management.

Adult↗
PubMedDate not supplied

Recruitment of research participants through the Internet.

Despite an increasing amount of Internet research, issues in recruitment for studies in this environment rarely have been discussed. The purpose of this article is to provide some future directions for participant recruitment via the Internet, based on the experiences of recruiting participants for three Internet survey studies. The issues in the recruitment process include those related to low response rates, selected groups of participants, the importance of timing, and potential ethical issues. Based on the discussion of the issues, the following suggestions are proposed for future recruitment through the Internet: use of creative motivation strategies; sensitivity to the gender, ethnicity, and socioeconomic status of potential participants; consideration of the timing of data collection; and sensitivity to potential ethical issues.

Adult↗