Development of a Short-Form Scale of Public Attitudes Toward Homelessness

Nationwide, demographic changes have led to an increased awareness of the impact of cultural diversity on the delivery of medical and psychological care. Due to the over-representation of minority and socially stigmatized groups among those affected by HIV, understanding the effects of psychosocial, linguistic and cultural membership or treatment relationships is crucial. In the psychological treatment of HIV-infected patients, psychotherapists can enhance the lives of their patients and support their involvement and compliance with medical treatment planning Case studies are presented in which psychotherapy helped resolve difficulties in the medical care of three HIV-positive women that were due to cultural misunderstanding between doctors and patients.     

Perceived Cultural Distance in Healthcare in Immigrant Intercultural Medical Encounters

This article responds to the paucity of empirical research on the impact of patient-provider ethno-cultural distance and providers' cultural competence on the quality of healthcare service in migrant intercultural medical encounters in Australia. A cross-sectional study was conducted with 447 patients, consisting of 195 Caucasian and 252 non-Caucasian patients from six outpatient clinics in New South Wales, Australia. Structural equation modelling was used for data analysis. The findings demonstrated that cultural distance is an influential factor in perceived quality of outpatient care. Caucasian and non-Caucasian patients' perception of cultural distance between their physicians and themselves affected their service quality ratings of their physicians' professionalism, empathy and expertise. This is the first study on healthcare service quality in outpatient clinics in Australia for Caucasian and non-Caucasian patients. Policy implications suggest intervention strategies and the need for cultural competence education in medical and health curricula in medical schools and clinical practices.     

Taming predators through photography

In this article we examine an innovative application of visual communication and social science methods, moving the study of indigenous media from the purely academic realm into pediatric health research. Through Video Intervention/Prevention Assessment (VIA), children and adolescents who share a medical condition create visual narratives of their lives with chronic disease to show and tell their illness experiences to health care providers. Clinicians routinely plan medical management with limited knowledge of how patients interact with disease in their “real life” physical, psychological, and social environments. VIA asks young patients to teach clinicians the realities of day‐to‐day life with illness, yielding unique insights that can guide the development of more realistic, more humane, and ultimately more effective medical care. We describe the VIA methodology, a pilot study of asthma, and the illness experiences shown and told by VIA Asthma participants. Not only did VIA generate useful research findings, it also produced visual documents of the child's illness experience that can serve as tools for influencing policy, advocating for patients, and educating health care providers, patients, and their families.     

Raising the "civilized minimum" of pain amelioration for prisoners to avoid cruel and unusual punishment

This Article addresses the problems with our nation's cultural and legal prohibitions against certain pain management treatments. The practice of pain management has not kept pace with the many medical advances that have made it possible for physicians to ameliorate most pain. The Author notes that some patients are denied access to certain forms of treatments due to the mistaken belief that addiction may ensue. Additionally, some individuals are under-treated for their pain to a greater degree than are others. This is especially the case for our nation's prisoners. The Author contends that prisoners are frequently denied effective pain amelioration. He notes, however, that there has been improvement in medical treatment in general for prisoners due to court challenges based on the Eighth Amendment's prohibition against cruel and unusual punishment. Yet, due to the protection of qualified immunity given to jailers and prison health care providers, prisoners cannot bring a claim for negligence or medical malpractice, they must allege a violation of their constitutional rights, a significantly higher legal standard. Prisoners must meet a subjective test showing that there was a deliberate indifference to their medical needs that violates the protection of the Eighth Amendment. The Author concludes that because medical advances have made it possible to alleviate most pain suffering, withholding pain treatment or providing a less effective treatment is tantamount to inflicting pain and should be viewed as a violation of the Eighth Amendment.     

Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

Medical care, living conditions, and children's well-being

We examine the effect of medical care and living conditions on children's physical and psychological well-being. We develop a causal model in which living conditions (including the socioeconomic status of the family and the social-psychological aspects of family functioning) may affect well-being both directly, and indirectly through medical care. We find that families in the higher social classes and families that function well tend to go to large prepaid groups where they receive good medical care. High quality technical care of illness, in turn, improves physical health. The quality of psychotherapeutic care, on the other hand, has no effect on psychological well-being. For this aspect of health, the effect of living conditions is largely direct, rather than indirect by way of medical care. Families characterized by high levels of functioning have children who are psychologically healthy. In addition, physical health affects psychological well-being, but not vice versa.     

Factors Affecting Older Women's Adherence to Medication and Treatment

Over the past 25 years, there has been a growing interest in why many patients do not take prescribed medications or fail to follow medical advice. As many as 50% of all patients fail to adhere adequately to therapeutic advice or engage in inappropriate use of prescribed medications. Additionally, there has been a struggle over how best to describe this variance between what medical practitioners recommend and what patients actually do. This article examines factors thought to affect women's adherence to medication and treatment regimens. Literature on age, comorbid conditions, socioeconomic factors, environmental factors, and perceived susceptibility for an illness is reviewed as are individual psychological idiosyncratic dynamics that may influence health care behaviors.     

Trauma screening in students attending a medical university

Clinicians seldom assess trauma history in patients who seek treatment for psychological problems, yet trauma exposure is often related to psychological distress. Assessing trauma history can provide valuable information for treatment conceptualization and provision, although patients may not spontaneously share their histories because of embarrassment, avoidance, or other concerns. The authors compared 73 students at a southeastern US medical university who sought counseling and psychological services and completed intake paperwork without a trauma screen with 130 students whose intake procedures included trauma screening. They found that (a) patients who were specifically asked about trauma history were more likely to report such events, (b) previous physical assaults with a weapon were related to current psychological distress, and (c) physical assaults with or without a weapon were related to clinically significant psychological distress. These findings suggest that screening for lifetime trauma history should be a standard part of mental health screenings in similar medical university counseling centers.     

Trauma Screening in Students Attending a Medical University

Abstract

Clinicians seldom assess trauma history in patients who seek treatment for psychological problems, yet trauma exposure is often related to psychological distress. Assessing trauma history can provide valuable information for treatment conceptualization and provision, although patients may not spontaneously share their histories because of embarrassment, avoidance, or other concerns. The authors compared 73 students at a southeastern US medical university who sought counseling and psychological services and completed intake paperwork without a trauma screen with 130 students whose intake procedures included trauma screening. They found that (a) patients who were specifically asked about trauma history were more likely to report such events, (b) previous physical assaults with a weapon were related to current psychological distress, and (c) physical assaults with or without a weapon were related to clinically significant psychological distress. These findings suggest that screening for lifetime trauma history should be a standard part of mental health screenings in similar medical university counseling centers.     

Long-term care planning as a cultural system

This paper treats long-term care planning from a cultural perspective, that is, as a cultural system in which components of long-term care interlock culturally and therefore meaningfully. In the introduction and background sections, we provide a context in which long-term care planning may be viewed, based on the finding that relatively few people take advantage of long-term care planning and insurance; we also discuss some earlier work on long-term care from a psychological perspective that emphasizes themes of imagination and self-efficacy. We then examine long-term care from a cultural perspective by identifying and explicating five broad themes that help us better understand the meaning of long-term care planning to Americans. Finally, we use these themes to suggest some important social policy correlates.     

Long-Term Care Planning as a Cultural System

Abstract

This paper treats long-term care planning from a cultural perspective, that is, as a cultural system in which components of long-term care interlock culturally and therefore meaningfully. In the introduction and background sections, we provide a context in which long-term care planning may be viewed, based on the finding that relatively few people take advantage of long-term care planning and insurance; we also discuss some earlier work on long-term care from a psychological perspective that emphasizes themes of imagination and self-efficacy. We then examine long-term care from a cultural perspective by identifying and explicating five broad themes that help us better understand the meaning of long-term care planning to Americans. Finally, we use these themes to suggest some important social policy correlates.     

Cross Cultural Perspectives in Treating the Gay Male Trauma Survivor

Summary

In recent years, there has been an increased emphasis on cultural considerations in psychotherapeutic treatment. Sound psychotherapy is ideally culturally sensitive and concerned with the context within which the client developed and exists. At the same time it is often difficult for many clinicians to navigate the cultural within the psychological framework. When both patient and clinician share more than one language in common, there are a variety of subtle issues that surface. In psychotherapy, “coordinate bilinguals,” those who learn their languages separately, during different developmental stages and contexts, tend to have greater access to their emotional experiences within their first language. When the client presents with a sexual trauma history, the language spoken during the abuse will also have an effect on the language used in the psychotherapy. The case history of Lucio, a Latino gay male, is discussed in terms of the cultural and psychological elements of his treatment by a bilingual North American therapist. This therapist's psychotherapeutic conceptualizations and treatment approaches are examined and reviewed in a written dialogue/ discussion with a Latino psychologist.     

Chinese Rural Health-Seeking Behaviour and the Dilemma of Sufferers of Chronic Sickness: A Case Study from Inner Mongolia

Chinese society is entering a ‘period of chronic sickness’, especially hypertension, hyperglycemia and hyperlipidemia, resulting from a more easily available diet rich in animal fat and protein. The damage is greatest in rural areas where medical and welfare facilities are limited and patients present late, which they justify as needing to continue farming despite sickness. Thus, contrary to Parsons’s observation regarding Western medical treatment, a patient’s sick role is neither ‘deviant’ nor separated from their everyday social role and lifestyle. Villagers might however be officially encouraged to regard biomedical, religious and traditional folk therapies as neither old-fashioned nor in conflict, but as a spectrum providing emotional/psychological and sometimes physical benefit, reinforced by returning to the greater community and family care existing before village social fragmentation. This recreation of a holistic perspective could enhance the quality of rural life, especially of chronic sickness sufferers.     

Experiences of vulnerability due to loss of support by aged parents of emigrated children: a hermeneutic literature review

ABSTRACT

In disrupted families due to migration individual members support each other through transnational care. The care is often reciprocal as the members who are left behind support the members who emigrated and in return receive care from the emigrated family members. Aged parents who get left behind, however, often become vulnerable. The hermeneutic literature review shows that social, psychological or emotional and economic vulnerability are experienced. They have to deal with cultural challenges as their children form part of a new culture in their receiving country. Strong feelings of loss, helplessness and loneliness are experienced. The emigration of their children may also contribute to the financial vulnerability of the elderly.     

Chinks in Gender?

This comment argues that differences between clinical and normal populations, between clinical data and sociological data, and differences in social class and cultural settings should be taken into account in order to understand the varying psychological dynamics behind self representations. Research from the Nordic countries indicates that young women's relationships with their mothers and fathers are becoming more similar. The daughters appreciate their mothers' ability to combine independent lives of their own with care for children and family, and fathers are to a higher degree than before perceived as warm and caring figures. This may imply that the gender-differentiated psychological roles of the mother and the father in the heterosexual nuclear family are becoming less distinct. If chinks undermine not only the merged attachment but also gender as such, this question arises: What ways and to what extent are the new psychological dispositions Susie Orbach describes actually gendered?     

Pediatrics: The emerging psychosocial challenges of the AIDS epidemic

HIV has a pervasive and profound effect on the psychological, social and neuropsychological functioning of infected infants, children and their families. This article discusses direct and indirect psychological manifestations of HIV in children. Direct effects are the outcome of the virus acting on the central nervous system and can result in compromised cognitive, language, motor, socio-emotional and motivational functioning. Indirect effects involve psychological responses to the stress of living with a life threatening illness, the social ostracism, disruption in life goals and undergoing frequent invasive and protracted medical procedures. A major focus of this article is to outline and describe a model comprehensive psychosocial support system developed within the Pediatric Branch of the National Cancer Institute. This includes early intervention issues and strategies for working with families during the introductory phase of the treatment program that also provides the framework for a care management approach, salient mental health problems that frequently occur in this group, and appropriate interventions for individuals and families. Attention is also given to dealing with anticipatory loss and bereavement, implementing traditional innovative intervention techniques, and for providing advocacy services concerning possible legal, financial, housing, and educational issues.     

An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: The significance of patient privacy,psychological health,and social stigma to care

We apply a social-ecological interpretive framework to understanding relationships among patient privacy, psychological health, social stigma, and continuity in care in the HIV treatment cascade in the rural southeastern US. This research was conducted as part of the 2013 comprehensive needs assessment for the Northeast Georgia Ryan White Consortium using an anthropologically informed mixed-methods design, and a deductive-inductive approach to thematic analysis of qualitative data obtained in interviews and focus groups with service providers and service utilizers. Our comprehensive needs assessment yielded two key components. First, we identified salient phenomena influencing introduction to, retention among, and satisfaction of patients in the Ryan White-coordinated treatment cascade in NE-GA. Second, we formulated actionable recommendations around leverage points identified in the current district-wide system of care. Results highlight spatial, institutional, and interpersonal aspects of the system of care that intersect around issues of patient privacy, psychological health, and social stigma. These intersections constitute pathways by which persons living with HIV are exposed to stigma and other negative social signals regarding their health status without sufficient access to behavioral health services. These negative issues, in turn, can erect significant barriers to long-term continuity in care.