Rehabilitation programs for elderly women inpatients with schizophrenia

This study aims to describe rehabilitation and resocialization methods we believe to be appropriate for application to female patients with schizophrenia, in a psychiatric unit with a predominantly older population. We briefly describe the unit and the interventions used as an example of the proposed rehabilitation and resocialization methods applied. The article provides an overview to guide accurate intervention, particularly in inpatient women, in different types of cognitive impairment under the broad category of schizophrenia. Our clinical approach includes a token economy approach, cognitive remediation therapy, and social skills training. The token economy intervention is particularly directed to patients that present with a high mental deterioration and/or debility. Cognitive remediation training is applicable to subjects with both cognitive and social dysfunction, but that do not possess signs of an organic cerebral illness or of substance abuse. Social skills training can be the third step to resocialization, training verbal and nonverbal communication competencies.     

Women,Aging, and Schizophrenia

SUMMARY

Schizophrenia is a psychiatric disorder of unknown etiology that typically has an onset in early adulthood and persists for the remainder of the life span. For most affected individuals, the illness is recurrent with psychotic symptoms that tend to be episodic in nature. The illness has pervasive and disruptive effects on many life domains; for example, women with schizophrenia are less likely to marry, bear children, and raise their own children than are women in the general population. The age of onset of schizophrenia is later on average in women than men, and women are overrepresented among those who develop the illness after the age of 45. Among younger patients with schizophrenia, women tend to have less severe symptoms than men and better outcomes; however, there are fewer gender differences among older patients with schizophrenia. Older women with schizophrenia are vulnerable to problems of both schizophrenia and aging. Schizophrenia symptoms typically continue in later years and include ongoing psychotic symptoms. Problems of aging such as cognitive decline and chronic medical conditions may be exacerbated by schizophrenia and the disorder is associated with premature mortality. Older women with schizophrenia are at risk for neglect of psychiatric and other health needs that are further compounded by limited social support and low socioeconomic status. More research and clinical attention is needed for the problems of older women with schizophrenia.     

Teaching assertive skills to a passive homosexual adolescent: an illustrative case study

Social skills training was used to alter the socially inappropriate and ineffectual behavior of a 17-year old homosexual male. Target behaviors selected for treatment were the subject's effeminate mannerisms and lack of assertiveness in conflict situations, especially those involving other persons making derisive comments to him. A multiple baseline design was used to increase the patient's (a) eye contact, (b) rate of making appropriate requests for behavior change in others, and (c) general level of assertive affect. Six training and six generalization role-played interpersonal scenes were used. Results indicated significant improvement on trained social skills components with generalization to nontrained scenes as well. Implications of these findings are discussed, particularly with respect to social skills and assertion training for effeminate homosexuals.     

Who gets over the training hurdle? A study of the training experiences of young men and women in Britain

Using longitudinal data from the British National Child Development Study, this paper examines gender differences in the determinants of work-related training. The analysis covers a crucial decade in the working lives of this 1958 birth cohort of young men and women – the years spanning the ages of 23 to 33. Hurdle negative binomial models are used to estimate the number of work-related training events lasting at least three days. This approach takes into account the fact that more than half the men and two thirds of the women in the sample experienced no work-related training lasting three or more days over the period 1981 to 1991. Our analysis suggests that reliance on work-related training to improve the skills of the work force will result in an increase in the skills of the already educated, but will not improve the skills of individuals entering the labor market with relatively low levels of education. JEL classification: C25, I21, J24. Received February 9, 1996/Accepted August 14, 1996     

The paradoxes of communication and collaboration in maternity care: A video-reflexivity study with professionals and parents

BackgroundResearch on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders – parents – as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for “good practice”.MethodsWe used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units.FindingsWe conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: “talk work” – small talk and humour – and “work beyond words” – familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves “paradoxical care”, e.g., concurrent acts of “regulated spontaneity” and “informal formalities”.DiscussionAcknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents.ConclusionGood communication and collaboration in maternity care involves “paradoxical care” requiring social sensitivity and self-reflection, skills that should be included as part of professional training.     

Empowerment-Oriented Social Work Practice: Impact on Late Life Relationships of Women

SUMMARY

Empowerment interventions promote egalitarian, strengths-based relationships through education, self-help, mutual support, consciousness raising, and social action activities. In this paper we describe the influence of empowerment-oriented group intervention on the relationships of older women. We conducted qualitative interviews with the women who participated in the group and the social workers who staffed the intervention activities. The findings suggest that, in addition to other empowerment outcomes, the older women participants developed sustaining relationships with each other and often seriously considered the nature of their other late life relationships. Thus, empowerment-oriented interventions can enhance the quality of life for older women, including the development and support of meaningful interpersonal relationships.     

Attitudes and Beliefs About Hepatitis B Vaccination Among Gay Men: The Birmingham Measurement Study

ABSTRACT

This study was designed to develop reliable and valid quantitative measures of the beliefs and attitudes toward hepatitis B virus (HBV) vaccination among gay men, using a community-based participatory research approach. A convenience sample of 358 gay men was recruited in two gay bars. Exploratory factor analysis performed on the first split-half sample was used to assess the factor structure from five scales measuring beliefs about HBV vaccination. The scales were based on constructs from the health belief model and the social cognitive theory. Confirmatory factor analysis was performed on the remaining half-sample using structural equation modeling. Multivariable analysis further validated the scales. These findings propose standardized measures that may be useful in assessing the beliefs and attitudes of gay men toward HBV vaccination to guide intervention design and evaluation.     

Cognitive Functioning and Aging in Women

SUMMARY

Deficits in cognitive function may impact one's ability to attend to stimuli, think clearly, reason, and remember. Impaired cognitive function is a common complaint among older women presenting for treatment in both mental health and medical care settings, and differential diagnosis of type and extent of cognitive impairment is important for appropriate treatment planning and prognosis. Although overall gender differences in prevalence of cognitive dysfunction are minimal, it is important when treating older women to take into account unique challenges they face in the aging process that impact the cause, type and extent of cognitive complaints with which they present in clinical settings. The current paper provides an overview to guide accurate diagnosis, particularly in women, of different types of cognitive impairment under the broad category of dementias, including Alzheimer's, Lewy Body Disease, Vascular Dementia, and due to general medical conditions such as coronary artery bypass surgery, head injury, menopause, hypothyroidism, breast cancer treatment, Fibromyalgia, and chronic fatigue. In addition, emotional factors such as depression in older female patients complicate differential diagnosis of cognitive impairment and must be addressed. Given the multiplicity of causes of cognitive difficulties for women across the life span, careful assessment is crucial; the current paper reviews assessment strategies to prepare an integrated, biopsychosocial strategy for identifying particular cognitive deficits and related psychological and medical problems. In addition, prognostic indicators and treatment planning are discussed to help the practitioner organize an empathic, reasoned and multifaceted treatment approach to maximize recovery, minimize deterioration, and manage symptoms for older women in the context of their social support system and living environment.     

The Social Context of Depression Symptomology in Sexual Minority Male Youth: Determinants of Depression in a Sample of Grindr Users

ABSTRACT

The purpose of this study was to understand which social context factors most influence depression symptomology among sexual minority male youth (SMMY). In 2011, 195 SMMY who use Grindr were recruited to complete an online survey in Los Angeles, California. Items focused on social context variables and depression symptomology. Hierarchical multiple regressions were conducted using an ecological framework. The best fitting model accounted for 29.5% of the variance in depression. Experiences of homophobia, gay community connection, presence of an objecting network member, and emotional support were found to be significant predictors. Past experiences of homophobia continuing to affect youth indicates the need for intervention to reduction of homophobia in youths’ social contexts. Interventions that teach youth skills to manage objecting viewpoints or help youth to reorganize their social networks may help to reduce the impact of an objecting network alter.     

“Who's afraid?”: Attitudes of midwives to the use of information and communication technologies (ICTs) for delivery of pregnancy-related health information

BackgroundUsage rates for information and communication technologies (ICTs) in healthcare have been increasing in recent years, but often lag behind general usage rates for populations as a whole. Research into such differential rates of ICT use across different segments of the population has identified a number of possible causal factors that limit usage.AimThe research investigated midwives’ attitudes and experiences of ICT use to identify potential causal factors that encourage or inhibit their usage in antenatal care.MethodsSemi-structured interviews, focus groups and short surveys were conducted with midwives who provide antenatal education at an Australian metropolitan hospital. Thematic and statistical analyses were used to interpret the data.FindingsAlthough midwives recognised the potential benefits of using ICTs to deliver pregnancy-related health information many had reservations about their use in everyday work. These reservations centred on lack of training in use of ICTs, the perceived legal risks associated with social media, potential violations of patient privacy, misdiagnosis and misunderstandings between midwife and client.ConclusionMidwives face a number of barriers to effective use of ICTs in healthcare including material access, skills access, usage access and motivational access. Motivational access appears to be a key concern due to the high perception of risk associated with social media in particular. Reducing the motivational barriers through a range of interventions with midwifery staff may assist in overcoming other barriers to ICT use in antenatal care. Further research is required to determine whether these findings are generalisable to other healthcare contexts.     

Dementia spousal caregivers and past transgressions: Measuring and understanding forgiveness experiences

ABSTRACT

The transition from “wife” to “caregiver” for a cognitively impaired husband can be an overwhelming experience. Communication patterns change and small conflicts can grow, at times bringing angry feelings and new burdens. Engagement with forgiveness processes may benefit wives by lowering resentment over past tensions, restoring trust, and enhancing the overall caregiving experience. This study examined the utility of the Enright Forgiveness Inventory (EFI) within a sample of caregiving wives. Our intent was to better understand this population’s experience with forgiveness when other contextual factors were likely to influence this process. Forgiveness scores on the EFI were positively related to the cognitive status of the care recipient, a particularly important finding for clinical intervention, and inversely related to marital distress and state anxiety.     

Women, aging, and schizophrenia

Schizophrenia is a psychiatric disorder of unknown etiology that typically has an onset in early adulthood and persists for the remainder of the lifespan. For most affected individuals, the illness is recurrent with psychotic symptoms that tend to be episodic in nature. The illness has pervasive and disruptive effects on many life domains; for example, women with schizophrenia are less likely to marry, bear children, and raise their own children than are women in the general population. The age of onset of schizophrenia is later on average in women then men, and women are over-represented among those who develop the illness after the age of 45. Among younger patients with schizophrenia, women tend to have less severe symptoms than men and better outcomes; however, there are fewer gender differences among older patients with schizophrenia. Older women with schizophrenia are vulnerable to problems of both schizophrenia and aging. Schizophrenia symptoms typically continue in later years and include ongoing psychotic symptoms. Problems of aging such as cognitive decline and chronic medical conditions may be exacerbated by schizophrenia and the disorder is associated with premature mortality. Older women with schizophrenia are at risk for neglect of psychiatric and other health needs that are further compounded by limited social support and low socioeconomic status. More research and clinical attention is needed to the problems of older women with schizophrenia.     

Is the German apprenticeship system a panacea for the U.S. labor market?

This paper explores the structure of incentives undergirding the German system of apprenticeship training. We first describe characteristics of the German labor market which may lead firms to accept part of the cost of general training, even in the face of worker turnover. We then compare labor market outcomes for apprentices in Germany and high school graduates in the United States. Apprentices in Germany occupy a similar position within the German wage structure as held by high school graduates in the United States labor market. Finally, we provide evidence that – in both countries – the problem of forming labor market bonds is particularly acute for minority youth. JEL classification: J24, J31, J60 Received: July 4, 1996 / Accepted February 4, 1997     

How do health professionals support pregnant and young mothers in the community? A selective review of the research literature

BackgroundThe cultural phenomenon of “teenage pregnancy and motherhood” has been socially constructed and (mis)represented in social and health care discourses for several decades. Despite a growing body of qualitative research that presents an alternative and positive view of young motherhood, there remains a significant gap between pregnant and young women's experience of young motherhood and current global health and social policy that directs service delivery and practice.AimThis paper aims to heighten awareness of how a negative social construction of young motherhood influences global health and social policy that directs current community health models of practice and care for young mothers in the community.DiscussionThere is clear evidence on the vital role social support plays in young women's experience of pregnancy and motherhood, particularly in forming a positive motherhood identity. This discussion paper calls us to start open and honest dialogue on how we may begin to re-vision the ‘deficit view’ of young motherhood in order to address this contradiction between research evidence, policy discourse and current practice and service provision. Qualitative research that privileges young women's voices by considering the multidimensional experiences of young motherhood is an important step towards moving away from universally prescribed interventions to a non-standard approach that fosters relational and responsive relationships with young mothers that includes addressing the immediate needs of young mothers at the particular time.     

‘The shops were only made for people who could walk’: impairment,barriers and autonomy in the mobility of adults with Cerebral Palsy in urban England

ABSTRACT

Based on research carried out with a group of adults with Cerebral Palsy in Birmingham, UK, we consider the complex inter-relationship between the accessibility of the urban environment for those with impaired gross motor skills, and the ability of these people to lead full and independent lives. Drawing on a framework that considers mobility as movement, meaning-making and political, we demonstrate the reality of differentiated mobility. For those with bodies that function outside the presumed operating parameters of the model subjects of urban design, mobility may be possible, but is often uncomfortable and even dangerous, with significant associated effects for impaired people’s autonomy. Our study details social and structural, or design, barriers to people’s mobility, demonstrating the inter-connection between individuals’ behaviour and urban design in a manner that questions a clear distinction between the two. We draw upon the notions of emotional work and a commoning approach to mobility in suggesting that further investment in urban accessibility is squarely an issue of social justice.     

A qualitative study of innovations implemented to improve transition of care from maternity to child and family health (CFH) services in Australia

BackgroundThe transition of care (ToC) from maternity services, particularly from midwifery care to child and family health (CFH) nursing services, is a critical time in the support of women as they transition into early parenting. However significant issues in service provision exist, particularly meeting the needs of women with social and emotional health risk factors. These include insufficient resources, poor communication and information transfer, limited interface between private and public health systems and tension around role boundaries. In response some services are implementing strategies to improve the transition of care from maternity to CFH services.AimThis paper describes a range of innovations developed to improve transition of care between maternity and child and family health services and identifies the characteristics common to all innovations.MethodsData reported were collected in phase three of a mixed methods study investigating the feasibility of implementing a national approach to child and family health services in Australia (CHoRUS study). Data were collected from 33 professionals including midwives, child and family health nurses, allied health staff and managers, at seven sites across four Australian states. Data were analysed thematically, guided by Braun and Clarke's six-step process of thematic analysis.FindingsThe range of innovations implemented included those which addressed; information sharing, the efficient use of funding and resources, development of new roles to improve co-ordination of care, the co-location of services and working together. Four of the seven sites implemented innovations that specifically targeted families with additional needs. Successful implementation was dependent on the preliminary work undertaken which required professionals and/or organisations to work collaboratively.ConclusionImproving the transition of care requires co-ordination and collaboration to ensure families are adequately supported. Collaboration between professionals and services facilitated innovative practice and was core to successful change.     

Talking testing: Impact of a training intervention on midwives’ antenatal HIV,hepatitis B and hepatitis C screening practice

BackgroundMidwives play a critical role in ensuring that HIV, hepatitis B and hepatitis C screening occurs during early pregnancy, in accordance with national consensus guidelines and policies. Limited opportunities exist for midwives to gain the knowledge, skills and confidence required to initiate testing discussions at the first antenatal visit.AimTo design, deliver and evaluate a workforce education intervention to build midwives’ capacity to initiate testing for HIV and viral hepatitis.MethodVictorian midwives were invited to enrol in an intervention which comprised a pre-learning package and a one-day study day covering clinical, epidemiological and psychosocial aspects of HIV, hepatitis B and hepatitis C testing in early pregnancy. A pre-/post-test design, incorporating a survey with eight knowledge items and four confidence items, was used to measure impact.FindingsOf the 69 participating midwives, 55 completed the pre-survey, 69 completed the post-survey and 19 completed a three-month follow up survey. Participant knowledge improved across all domains, with the most significant increases in the areas of HIV and viral hepatitis testing, transmission and treatment. Midwives’ confidence levels increased following the intervention, and this was generally sustained among the smaller sample at the three-months.ConclusionOur findings demonstrate that short educational interventions, designed and delivered by content experts, result in longer-term improvements in clinical practice which are crucial to ensuring women and their partners are given adequate information and recommendations about screening for HIV, hepatitis B and hepatitis C and during pregnancy.     

Assessment of Older Women with Chronic Pain

Females suffer from a larger number of chronic pain syndromes, live longer with chronic pain and disability, and more often live alone than males. Thus, they should be prime candidates for pain treatment. Yet a number of factors inhibit geriatric patients from receiving rehabilitation for their pain. Chronic pain has been determined to be a complex perceptual event that is influenced by psychosocial, behavioral, and biomedical factors. A comprehensive strategy for assessing chronic pain patients is described. Special attention is given to the association between pain and depression and the important medication of perceived interference with life, social support, and functional activities as these variables appear to be particularly relevant to a geriatric pain population.     

The experience of rural midwives in dual roles as nurse and midwife: “I’d prefer midwifery but I chose to live here”

ObjectiveTo explore and describe the experiences of working in the dual role as nurse and midwife in rural areas of far north Queensland, Australia.MethodThe methodology was informed by Heidegger's interpretive phenomenological philosophy and data analysis was guided by van Manen's analytical approach. Data was generated by conversational interviews. Eight midwives working in a dual role as midwife and nurse were interviewed individually.FindingsThree themes were identified: Making choices between professional role and lifestyle: “Because I choose to live here”; Integration of maternity and general nursing: “All in together this fine weather” and: “That's part of working in a small place”.ConclusionParticipants recognized that in rural areas it is important to be a multi-skilled generalist; however they were concerned that midwifery skills could be eroded or even lost with the diminishing amounts of midwifery work available. Appropriate re-structuring of maternity services could provide better use of the midwifery workforce in rural centres, and reduce the current problems associated with transferring birthing mothers to larger facilities. Further research is needed to examine the extent to which the requirement to work in a dual, or multifaceted role is an impediment to the recruitment and retention of midwives to rural areas.