Women with Turner's Syndrome: helping them reach their full potential

The physical and psychological effects of Turner's Syndrome, a female sex chromosome abnormality, briefly are described. Principles for helping women master the special challenges posed by the disorder are discussed. The authors argue that women with TS must take control of defining their identities and potential in order to attain full status within society.     

Assessing the Concept of the ‘Insecure‐Other’ Category in the Cassidy–Marvin Scheme: Changes Between 4 and 6 Years in the English and Romanian Adoptee Study

We set out to explore the meaning of the attachment categories in the Cassidy/Marvin strange situation procedure, as employed in the home, using data from a longitudinal study of children adopted into UK families up to the age of 42 months from Romanian institutions, and of adopted children without the experience of institutional care––both groups being assessed at 4 and 6 years of age. Inter‐rater reliability was found to be good. Security (meaning the use of the parent as a secure base and no negative behavior on reunion) was the modal categorical rating in both the institution‐reared and comparison groups, but the category of anomalous non‐normative behavior (meaning a lack of any ordered attachment behavior as covered by the standard ratings), previously labeled ‘insecure‐other’, was more common in the institution‐reared children. Because this was unassociated with the usual manifestations of insecurity (such as avoidance or resistance) and because it was largely evident in interactions with the stranger, it is concluded that the adjective ‘insecure’ was not appropriate. Although this ‘insecure‐other’ category was associated with disinhibited attachment as reported by parents (meaning a lack of differentiation among adults, a willingness to go off with strangers and a lack of checking back with parents in anxiety‐provoking situations), it did not prove to be a good index of disinhibited attachment because changes over time in the ‘insecure‐other’ category were not associated with changes in the rate of disinhibited attachment. Also, whereas the rate of ‘insecure‐other’ fell markedly in the institution‐reared group between 4 and 6 years of age, it rose in the comparison group, raising queries over its meaning.     

A Framework for Enabling Evidence-based Practice in Allied Health

Evidence-based practice (EBP) is upheld as best practice in health and human services but there is a need for more research on how this approach can be enabled in day-to-day practice. This qualitative study examined EBP with allied health managers and practitioners in a health service network (n = 17). The findings highlight the systemic nature of EBP and the extent to which it involves both individual and environmental attributes. Individual attributes include clear understanding of EBP, relevant knowledge and skills, and motivation and passion. Environmental attributes are the presence of an organisational culture that values and prioritises EBP and an integrated mix of research support services, professional development activities, supervision and mentorship, and university partnerships. Theoretical frameworks can be useful for making sense of complex processes, planning, and evaluating change. Therefore, the findings are presented as a framework incorporating reflective questions relating to the elements identified as enabling EBP.     

Leaving an Institution in Flanders (Belgium): A Road to Homelessness?

People living in an institution will leave this residential context one day and have to proceed to a stable independent way of living. This transition is not without difficulties as it turns out this socially vulnerable group runs an increased risk of becoming homeless. Research in Flanders (Belgium) has shown that a considerable share of the homeless population has previously stayed in an institutional setting, mostly in youth care (48.7%), psychiatric (34.4%) and penitentiary (33.1%) institutions. Moreover, the share of homeless people with a history in one of these institutions has increased in the past decades. Institution leavers, face at least three obstacles to a stable housing situation in Flanders: a lack of affordable housing, a lack of access to (non-residential) social assistance and personal difficulties in coping with living independently. Yet, there are several programs that support institution leavers and prepare them for the transition to an independent living situation and legal developments that strengthen their position in society and on the housing market. In this paper, we explore these initiatives and developments in three case studies (Antwerp, Ghent and Leuven). Based on in-depth interviews with “street-level bureaucrats” who work in these institutions (youth care, psychiatric and penitentiary settings), social support services and social housing organizations, we reconstruct the pathways of institution leavers to the housing market, the support they receive and the experienced difficulties.     

Einsatz von Simulationspatienten im Kommunikations- und Interaktionstraining für Medizinerinnen und Mediziner (Medi-KIT): Bedarfsanalyse — Training — Perspektiven

Communication skills are of central importance within daily medical life providing effective treatment. In the modern high-tech field of medicine, trustful conversations play a prominent role. In order to help students of the Heidelberg Medical Faculty to be ready for their highly responsible role as communication partner, training is carried out in the framework of HeiCuMed (short for Heidelberger Curriculum Medicinale) using specially trained simulation patients. The communication and interaction training program (referred to as Medi-KIT) enables to practice conducting conversations with challenging communication partners and grave conversational content in difficult situations. Feedback from the standardized patients, as well as from peers and tutors represents a central didactic element.In order to secure knowledge transfer into daily clinic life and as well to build a relation to cognitive knowledge transfer, all medical students are assigned, alongside Medi-KIT lessons, to a ward, and training units are coordinated in terms of content to correspond with symptom-oriented lectures and parallel POL-groups (problem-oriented learning groups). In addition, communication learning objectives are examined at the end of the semester in the form of a clinical practical exam (OSCE: Objective Structured Clinical Examination) and at patient’s bedside (Mini-CEX: Mini Clinical Examination). The goal in imparting communication skills within medical education is that the longitudinal communication curriculum be maintained and continued in subsequent medical specialization studies.     

Sanctioning as a social norm: Expectations of non-strategic sanctioning in a public goods game experiment

Sanctioning increases cooperation in public goods games, but not indiscriminately under all conditions and in all societies, and the mechanisms by which sanctioning exercises its impact on behavior are yet to be studied in detail. We show experimentally that in the presence of sanctioning, our experimental subjects adjust their behavior in order to avoid being a free rider. They do this not only in the STANDARD sanctions treatment, where they directly experience any sanctions assigned to them, but also in our main treatment, the SECRET sanctions treatment, where no information on sanctions received is available until the end of the experiment. We observe no such free riding avoidance in the treatment without sanctioning. The mere knowledge that sanctions might be assigned increases cooperation among the members of our subject pool; subjects expect that non-strategic sanctioning occurs against the free riders. Moreover, these expectations are correct as we observe a similar pattern and extent of sanctioning in both treatments. We propose that sanctioning in itself is a social norm and may be culturally dependent, as suggested in the literature.     

Getting Out and About: The Relationship Between Urban Form and Senior Travel Patterns

As the overall U.S. population expands outward from the central city and core suburbs and as people age in place, more seniors will reside in suburban and exurban locations. This research seeks to determine whether older adults who live in areas with differing urban forms experience travel pattern variations under controls for other factors related to travel. We analyzed data from a telephone survey of a random sample of seniors aged 75 years and older and we employed a unique approach for establishing the urban form of their residential settings. The results show that urban form does influence travel patterns, including the number of trips and transportation mode, and suggest that the construction of compact, mixed-use communities where today's older adults can age in place may be part of the solution to addressing the mobility needs of our aging population.     

Comparison of the characteristics of homes for older people in Slovenia with Goffman's concept of the total institution

The past concepts of life and work in homes for older people in Slovenia are no longer adequate to meet the needs, wishes and requirements of their current users. One of the basic premises, relying on Goffman's concept of the total institution, is that the first and foremost characteristic of homes for older people is that they are institutions. The theoretical starting point, namely that Goffman's concept of the total institution is ideal-typical, was corroborated by an investigation of the presence of elements of the total institution in Slovenian homes for older people, proving that not all features of the total institution can be found in any chosen empirical selection of institutions, with the data showing that those characteristics which are present do not exist in the ideal, that is in the most pronounced form. The homes’ users are given consideration, their personnel are adapting to their needs and requirements, even though this occurs within the functioning of an institution whose aims, i.e. to care for a large number of people living in one place, make life in such an institution subordinated to rules, along with the bureaucratisation and routinisation of services.