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PubMed2000

Interventions for encouraging sexual lifestyles and behaviours intended to prevent cervical cancer.

BACKGROUND: Cervical cancer is one of the most common cancers affecting women world-wide. Prevention falls into two main categories - primary and secondary. Primary prevention is characterised by health promotion to promote lifestyles and behaviours minimising risk of cervical cancer. Interventions to promote the use of condoms for sexual intercourse (especially early intercourse amongst young women), sexual partner reduction, and negotiated safer sex strategies has been recommended as one approach to limit the spread of Human Papilloma Virus (HPV), one of the major risk factors for cervical cancer. OBJECTIVES: To determine the effectiveness of health education interventions to promote sexual risk reduction behaviours amongst women in order to reduce transmission of HPV. SEARCH STRATEGY: Electronic searching of EMBASE, ERIC, MEDLINE, PsycLIT, Social Science Citation Index and the CCTR were undertaken using a highly sensitive search strategy. Hand-searching took place of selected journals and reference lists. SELECTION CRITERIA: Studies were included if they evaluated educational interventions targeting women only, and measured the impact on : either a behavioural outcome such as condom use for sexual intercourse, partner reduction, or abstinence; or a clinical outcome such as incidence of a sexually transmitted disease (STD). DATA COLLECTION AND ANALYSIS: Data were extracted and methodological quality was assessed independently by two reviewers and any discrepancies were resolved between them. Ten per cent of the total number of studies were reviewed additionally by a third reviewer as a quality check and differences in judgement were resolved accordingly. MAIN RESULTS: Thirty trials met the inclusion criteria for the review. All of them had the primary aim of preventing HIV and other STDs rather than cervical cancer. Four core methodological qualities were present in 10 of the 30 studies and constitute the subset from which potentially reliable conclusions may be drawn. Each of the 10 studies showed a statistically significant positive effect on sexual risk reduction, typically with increased use of condoms for vaginal intercourse. This positive effect was generally sustained up to three months after intervention. REVIEWER'S CONCLUSIONS: Educational interventions targeting socially and economically disadvantaged women in which information provision is complemented by sexual negotiation skill development can encourage at least short-term sexual risk reduction behaviour. This has the potential to reduce the transmission of HPV, thus possibly reduce the incidence of cervical carcinoma.

Female↗
PubMedDate not supplied

Social and psychological perspectives on voluntary sterilization: a review.

This paper reviews social science research on the antecedents and consequences of voluntary sterilization. The major conclusions are that socioeconomic status has little impact on the decision to be sterilized and that sterilizations are rare among those without sons and among male non-whites. Significant others are important sources of encouragement and information, and good marital relations increase the likelihood of having the procedure performed. Most acceptors experience no change in sexual activity, quality of marital relationships, or work-related behavior, and few regret their choice. Negative consequences are more likely among those in India, those coerced into having a sterilization, those who did not understand the consequences of the procedure, those with health complications after sterilization, and those couples who have unstable marriages or who disagree about sterilization.

Adult↗
PubMed1997

Primary prevention mental health programs for children and adolescents: a meta-analytic review.

Used meta-analysis to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents. Findings provide empirical support for further research and practice in primary prevention. Most categories of programs produced outcomes similar to or higher in magnitude than those obtained by many other established preventive and treatment interventions in the social sciences and medicine. Programs modifying the school environment, individually focused mental health promotion efforts, and attempts to help children negotiate stressful transitions yield significant mean effects ranging from 0.24 to 0.93. In practical terms, the average participant in a primary prevention program surpasses the performance of between 59% to 82% of those in a control group, and outcomes reflect an 8% to 46% difference in success rates favoring prevention groups. Most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies. Priorities for future research include clearer specification of intervention procedures and program goals, assessment of program implementation, more follow-up studies, and determining how characteristics of the intervention and participants relate to different outcomes.

Adolescent↗
PubMed2005

Networks and epidemic models.

Networks and the epidemiology of directly transmitted infectious diseases are fundamentally linked. The foundations of epidemiology and early epidemiological models were based on population wide random-mixing, but in practice each individual has a finite set of contacts to whom they can pass infection; the ensemble of all such contacts forms a 'mixing network'. Knowledge of the structure of the network allows models to compute the epidemic dynamics at the population scale from the individual-level behaviour of infections. Therefore, characteristics of mixing networks-and how these deviate from the random-mixing norm-have become important applied concerns that may enhance the understanding and prediction of epidemic patterns and intervention measures. Here, we review the basis of epidemiological theory (based on random-mixing models) and network theory (based on work from the social sciences and graph theory). We then describe a variety of methods that allow the mixing network, or an approximation to the network, to be ascertained. It is often the case that time and resources limit our ability to accurately find all connections within a network, and hence a generic understanding of the relationship between network structure and disease dynamics is needed. Therefore, we review some of the variety of idealized network types and approximation techniques that have been utilized to elucidate this link. Finally, we look to the future to suggest how the two fields of network theory and epidemiological modelling can deliver an improved understanding of disease dynamics and better public health through effective disease control.

Animals↗
PubMed2004

Economies of scale in institutional review boards.

BACKGROUND: Research with human subjects is essential for most clinical and social science research. As such, the ethical treatment of subjects, including the role of Institutional Review Boards (IRBs), is of paramount concern. The prevailing system of IRBs in the United States reflects an integrated approach in which research organizations have their own local IRB. Recent regulatory changes and a few high-profile problems have prompted proposals for greater investments in IRBs. OBJECTIVES: We conducted regression analyses, looking at how IRB size was associated with IRB costs (economies of scale). RESEARCH DESIGN: We studied data from a cross-sectional survey. SUBJECTS: We studied IRBs at Veterans Affairs (VA) and VA-affiliated medical centers (n = 109); 81 (73%) IRB administrators completed the survey. Fourteen of the administrators had missing data and were excluded from final analysis, leaving a sample of 67. MEASURES: The primary dependent variable was IRB costs in 2001, which we estimated from the survey. Independent variables included IRB size measured as the number of actions (ie, number of initial reviews, amendments, continuing/annual reviews, and harms/adverse event reports) reviewed by the IRB in the last year. RESULTS: The results indicate that very large economies of scale exist, especially for IRBs that handle fewer than 150 actions per year. CONCLUSIONS: A discussion of the costs of benefits of having 3000 to 5000 local IRBs in the United States is warranted because other organizational arrangements could be economically and socially advantageous.

Clinical Protocols↗
PubMed2006

Physicians perception of health insurance in Saudi Arabia.

OBJECTIVE: To assess physicians views on health insurance and its implication on the health care system. METHODS: We carried out a cross-sectional study in 2 major hospitals in Riyadh, Kingdom of Saudi Arabia. Data were collected from January to December 2002 through self-administered questionnaires that were distributed to a total sample of 400 physicians. The instrument consisted of 28 items that focused on assessing physicians' perception towards health insurance and its effect on health services. We performed a descriptive statistics and analysis of variance using the Statistical Package for Social Sciences. RESULTS: Overall, 151 physicians (38%) completed the survey. This study clearly shows that access to health care services is a major concern; more than 94% of the respondents agree that everyone in the Kingdom should have access to healthcare services. Respondents also agree that health insurance will improve access to healthcare services for all citizens. Physicians also believed that health insurance would lead to more regulations and utilization review of services, create more competition between healthcare providers, and create new jobs in the healthcare sector. Saudi physicians reported a higher mean score for 11 items with significant p-values as compared with non-Saudi physicians. CONCLUSION: Physicians in this survey believed that accessibility is a major policy concern, and that health insurance will have a positive effect on access to the health care system. Yet, accessibility is an illusive term with many aspects that go beyond the identification of need for health care to the actual delivery of health care services and the organizational structures to match the needs of society. Cooperation as a national health system should be built on collaborative efforts rather than market competition in itself. It has been suggested that markets are stronger in the role of delivery than in the financing of health care, that markets tend to promote more expenditure on technological innovation rather than producing the most desired set of social outcomes. Cooperative health insurance can be an answer to the current problems facing the health care system in the Kingdom of Saudi Arabia as long as it remains cooperative rather than competitive.

Attitude of Health Personnel↗
PubMed1989

The political economy of workers' health and safety.

The paucity of social science research on workers' health and safety (WHS) is noted and a framework based on class struggle within the capitalist political economic world-system is suggested. It is hypothesized that the historical and current strengths of workers' movements within nation states will largely determine the adequacy of provisions for WHS. This hypothesis was generally confirmed through field studies in Sweden, Finland, the German Democratic Republic, the Federal Republic of Germany, the U.K. and the U.S.A. However, one key aspect, the linkages between the general health services, especially at points of first entry (sometimes inappropriately referred to as primary health care, PHC) and WHS are highly problematic in all systems. Workers and their representatives, as well as concerned WHS and public health workers should develop greater awareness, concern and understanding of this PHC-WHS problem as well as other aspects of WHS.

Europe↗
PubMed1985

[Psychosocial counseling in pediatric practice--report of experiences].

The authors report on the activities of a female consultant with psychosocial orientation acting within the framework of a practising lady paediatrician's medical activities. The paediatrician refers patients or families to the social sciences consultant who studied paedagogics, sociology and psychology and who is so to say part of the paediatric consultation work. This amounts to an approach to an integrated type of treatment. It is an attempt to extend the old therapeutic concept of "disease", which has been mainly directed at cure and at treating the human organism, via practical interaction between various fields of human activity. Paediatric medicine lends itself quite easily to such an approach on the basis of experience collected in the course of time. The authors give a systematised description of the consultant practice, showing the boundary-lines of competencies. A few practical cases are outlined. The authors consider this set-up as an attempt to effect structural improvements of general medical care.

Child↗
PubMed2001

Learning oral presentation skills: a rhetorical analysis with pedagogical and professional implications.

OBJECTIVE: Oral presentation skills are central to physician-physician communication; however, little is known about how these skills are learned. Rhetoric is a social science which studies communication in terms of context and explores the action of language on knowledge, attitudes, and values. It has not previously been applied to medical discourse. We used rhetorical principles to qualitatively study how students learn oral presentation skills and what professional values are communicated in this process. DESIGN: Descriptive study. SETTING: Inpatient general medicine service in a university-affiliated public hospital. PARTICIPANTS: Twelve third-year medical students during their internal medicine clerkship and 14 teachers. MEASUREMENTS: One-hundred sixty hours of ethnographic observation. including 73 oral presentations on rounds. Discoursed-based interviews of 8 students and 10 teachers. Data were qualitatively analyzed to uncover recurrent patterns of communication. MAIN RESULTS: Students and teachers had different perceptions of the purpose of oral presentation, and this was reflected in performance. Students described and conducted the presentation as a rule-based, data-storage activity governed by "order" and "structure." Teachers approached the presentation as a flexible means of "communication" and a method for "constructing" the details of a case into a diagnostic or therapeutic plan. Although most teachers viewed oral presentations rhetorically (sensitive to context), most feedback that students received was implicit and acontextual, with little guidance provided for determining relevant content. This led to dysfunctional generalizations by students, sometimes resulting in worse communication skills (e.g., comment "be brief" resulted in reading faster rather than editing) and unintended value acquisition (e.g., request for less social history interpreted as social history never relevant). CONCLUSIONS: Students learn oral presentation by trial and error rather than through teaching of an explicit rhetorical model. This may delay development of effective communication skills and result in acquisition of unintended professional values. Teaching and learning of oral presentation skills may be improved by emphasizing that context determines content and by making explicit the tacit rules of presentation.

Communication↗
PubMed1979

Circumplex model of marital and family system: I. Cohesion and adaptability dimensions, family types, and clinical applications.

The conceptual clustering of numerous concepts from family therapy and other social science fields reveals two significant dimensions of family behavior, cohesion and adaptability. These two dimensions are placed into a circumplex model that is used to identify 16 types of marital and family systems. The model proposes that a balanced level of both cohesion and adaptability is the most functional to marital and family development. It postulates the need for a balance on the cohesion dimension between too much closeness (which leads to enmeshed systems) and too little closeness (which leads to disengaged systems). There also needs to be a balance on the adaptability dimension between too much change (which leads to chaotic systems) and too little change (which leads to rigid systems). The model was developed as a tool for clinical diagnosis and for specifying treatment goals with couples and families.

Adaptation, Psychological↗
PubMedDate not supplied

Recipients of oocyte donation: an integrative review.

OBJECTIVE: To conduct a systematic review of published research to provide a synthesis of the psychosocial characteristics of donor oocyte recipient women. DATA SOURCES: The sample of published studies was selected from 1983 to September 2002. Retrieval of the studies used online computer searches from CINAHL, MEDLINE, PsycINFO, and Wilson's Social Science Abstracts using the terms reproduction techniques, in vitro fertilization, oocyte donation, oocyte recipients, and egg donation; citations from references and bibliographies of previously located articles; and two 60-minute retrieval sessions with a librarian specializing in health science literature. STUDY SELECTION: The majority of studies retrieved were completed in the natural sciences. The final sample resulted in 16 studies. DATA EXTRACTION: Each study was read and the data were extracted using a survey instrument developed by the investigator. DATA SYNTHESIS: Multiple methodologies were used in the sample; most were exploratory, retrospective, and descriptive studies. Thus, the data were analyzed using a qualitative discursive approach. A total of 827 donor oocyte recipient women participated in the studies. CONCLUSIONS: Published research investigating the psychosocial characteristics of donor recipient women was categorized into six focused areas: motivation; desired donor characteristics; selection of a known versus an anonymous donor; demographic, educational, and psychosocial profiles; disclosure of the method of conception to family members, friends, and the resulting child; and the relationship between the oocyte recipient and her resulting offspring. Research involving the psychosocial aspects of donor oocyte recipient women is in the infancy stage.

Attitude to Health↗
PubMed2006

When one's main effect is another's error: material vs. psychosocial explanations of health disparities. A commentary on Macleod et al., "is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men" (61(9), 2005, 1916-1929).

Two pathways by which socioeconomic factors result in health disparities are the material and the psychosocial. Recently, Macleod and colleagues reported on data showing that a subjective measure of workplace status was not as strongly related to mortality as were objective indicators and that another psychosocial measure, perceived stress, did not mediate the impact of these indicators [Macleod et al., 2005. Is subjective social status a more important determinant of health than objective social status? Evidence from a prospective observational study of Scottish men. Social Science & Medicine, 61(9), 1916-1929]. They suggest that the failure of these variables is indicative of the relative insignificance of psychosocial influences on health. This commentary argues for a different approach to examining these pathways. Efforts to demonstrate the failure of variables to predict health have the usual difficulties of trying to prove the null hypothesis. In this instance, problems in the conceptualization and measurement of psychosocial variables may account for the null results. Psychosocial and material factors are not mutually exclusive but, rather, are complementary. Unexplained variation in health when material factors are accounted for may be explained in part by psychosocial factors and vice versa. Collaboration between researchers who understand each of these domains will yield the greatest benefit in terms of understanding the processes leading to health disparities and providing multiple approaches for eliminating them.

Administrative Personnel↗
PubMed2006

The use of the life course paradigm and life course charts to explore referral for family history of breast cancer.

BACKGROUND: Life course research methodologies are used extensively in historical and social science research. In 1998 the life course paradigm was introduced to provide a way of tracing the interplay of person and setting. The method has had a very limited use in nursing research, but in this study it was utilized as a way of capturing dynamic change by placing the individual within a context of four domains; location in time and place, linked lives, human agency and timing of lives. OBJECTIVE: To describe the paradigm, review its use in healthcare research and provide a specific example of its use in healthcare. DESIGN: This paper discusses a novel method of creating life course charts for a qualitative study exploring the differing experiences of women referred from primary care to specialist services due to a family history of breast cancer. SETTING: A nurse-led breast cancer family history clinic in the UK. PARTICIPANTS: Twenty-two women. METHODS: Life charts were used in conjunction with a grounded theory approach to analyse data collected from semi-structured interviews. FINDINGS: Twenty-two life charts were created and the ability to layer the charts of multiple women to visualise similarities and differences aided the analysis. The life charts were a useful tool in the development of theoretical understandings and the psychosocial process of realisation of risk emerged as central to the initiation of referral. This was often apparent when approaching the age of an affected relative (anticipated onset) or when current circumstances emulate past experience (generational transference). CONCLUSIONS: This approach to charting complex psychological, social and contextual factors throughout the life course was methodologically beneficial and could have a wider utility in nursing and healthcare research. As a research tool it enhanced a holistic approach to patient care issues and was helpful as an aid to understanding health behaviours linked to familial risk.

Adaptation, Psychological↗
PubMed2001

Do community-based support services benefit bereaved children? A review of empirical evidence.

AIMS: To consider the evidence of effect from English language, empirically based quantitative evaluations of community-based interventions for bereaved children; community-based interventions being understood as those taking place outside a clinical setting. METHODS: MedLine, PsychInfo, Applied Social Sciences Index and Sociological Abstracts were searched for documents containing the words 'child', 'bereavement' and 'program', 'group', 'intervention', 'support' or 'evaluation'. The criterion for inclusion was that studies use a control group or pre- and post-test measurements using a standardized instrument. RESULTS: Nine relevant studies were identified. However, empirical evidence of positive outcomes for children was limited and compromised by methodological weaknesses in the design of the studies. Small sample sizes, irregular attendance, high levels of attrition, short time scales between pre- and post-testing and difficulty in developing appropriate instrumentation, including assessment of adherence to the agreed intervention programme, all created problems. CONCLUSIONS: The case for universal inclusion of this group of children in such support programmes remains unproven, and further exploration of the outcomes of a range of different community interventions is required, with a specific focus on long-term and/or unwanted effects and evaluation of the basis for referral.

Bereavement↗
PubMed2003

Stalking and other forms of intrusive contact after the dissolution of adolescent dating or romantic relationships.

Social science research has recently begun to focus on stalking and other forms of intrusive contact occurring among adolescents and young adults. This article presents results from a survey of 681 undergraduates about their experiences with stalking or other forms of intrusive contact occurring after the end of a dating or romantic relationship. Twenty percent of the respondents had been the target of intrusive contact, 8% had initiated intrusive contact, and 1% had been the target of intrusive contact after one relationship and had initiated intrusive contact after another. More females than males were the target of intrusive contact; however, there were no sex differences associated with initiating intrusive contact. About 20% of the respondents had feared for their safety during the intrusive contact. Thirty-one percent of the respondents described the intrusive contact as having a decidedly negative influence on either their subsequent dating relationships or their lives in general.

Adolescent↗
PubMed2002

The communication of information about older people between health and social care practitioners.

AIM: to provide an evidence base for strategies, and effectiveness of the transfer of patient information between hospital and community for older people with physical illness. DESIGN: a systematic review of qualitative and quantitative literature. SEARCH STRATEGY: literature from medical, health-related and social science databases as well as work in progress from national databases, the Internet, British PhD theses and other grey literature and policy documents. SELECTION CRITERIA: literature relating to similar healthcare systems published between January 1994 and June 2000 on hospital discharge planning. Empirical studies from peer reviewed sources; theoretical papers from non-peer reviewed sources; research papers from non-peer reviewed sources and professional documents. DATA COLLECTION AND ANALYSIS: extracted data from empirical studies under the headings of location, sector, research questions and study design and duration. We made structured summaries of all other data sources and used them to supply context and background. We categorized literature and analysed it in terms of method and analysis, quality and strength of evidence and its relevance to the research questions. We synthesized the results and presented them in terms of answers to our research questions. RESULTS: a database of 373 potentially relevant studies and of these, 53 were accepted for further analysis. Thirty-one were empirical studies, most of which were qualitative or a combination of qualitative and quantitative in design. The most effective strategy for transferring information is the appointment of a 'key worker', who can provide a point of contact for workers from hospital and community. Nevertheless, problems have arisen because both settings are under pressure and pursuing different goals. Neither setting is fully aware of the needs, limitations and pressures of the other. CONCLUSION: raised awareness and the establishment of common goals are the first steps needed to bridge the divide between health and social care staff in hospital and the community.

Aged↗
PubMed2006

Conflict within nursing work environments: concept analysis.

AIM: The aim of this paper is to examine the concept of conflict in nursing work environments using the evolutionary approach to concept analysis. BACKGROUND: In nursing work environments, conflict among nurses is becoming a significant issue resulting in job dissatisfaction, absenteeism, and turnover. Although discussed frequently in the nursing literature, nursing research has focused predominantly on conflict management without first understanding the elements, causes and effects of conflict. METHODS: A literature search was conducted using CINAHL, Proquest, PsychINFO, Social Sciences Index and MEDLINE databases and the keywords conflict and work environment. Articles over the last 25 years from each of these databases were examined to identify major themes, areas of agreement and disagreement across disciplines, changes in the concept over time, and emerging trends. FINDINGS: Conflict is a multidimensional construct with both detrimental and beneficial effects. Most definitions agree that conflict is a process involving two or more people, where a person perceives the opposition of the other. Antecedents stem from individual characteristics, interpersonal factors, and organizational factors. Individual effects, interpersonal relationships, and organizational effects are the main consequences of conflict. A theoretical model of the antecedents and consequences is presented, with implications for further development. CONCLUSIONS: A more thorough understanding of the sources and outcomes of conflict within nursing work environments would enable the prevention of conflict. If properly understood and managed, conflict can also lead to positive outcomes for nurses and healthcare organizations.

Attitude of Health Personnel↗