Prevention of osteoporosis: one step forward, two steps back

For many years, hormone replacement therapy (HRT) was the mainstay for osteoporosis prevention in postmenopausal women until a large randomized clinical trial raised serious safety concerns. This resulted in a big drop in HRT use and its demotion by regulatory authorities to second-line treatment. Many clinicians now feel that HRT is not safe to use, and recommend various alternatives for the treatment of osteoporosis. But how effective are these alternative therapies, are they any safer than HRT, and how do their costs compare? This review questions the validity of the safety concerns about HRT, and highlights the safety concerns about alternative therapies. It concludes that HRT is as safe as the other treatment options, and its efficacy and low cost demand that it be restored as a first-line treatment for the prevention of postmenopausal osteoporosis. Other therapies are available for use in osteoporosis, and the bisphosphonates are particularly effective for the treatment of the established disease. However, they must be used selectively and with caution, and are best restricted to those patients who are elderly or have severe disease. New treatments are emerging, but again caution must be taken until any long-term adverse effects have been identified.     

A holistic approach to stakeholder management: A rhetorical foundation

The day-to-day concerns of managing stakeholders are a critical matter for public relations practitioners and scholars alike. “Stakeholder theory” subsumes the knowledge base about stakeholders, who are individuals and groups who affect or are affected by an organization's actions. This article argues that a holistic view of stakeholder management rests on rhetorical grounds and concerns answering three fundamental questions: (1) How are stakeholders created? (2) How can relationships with stakeholders be maintained? and (3) How can relationships with stakeholders be improved? Example cases are used to demonstrate how retrospective analysis reveals the effectiveness of stakeholder management approaches. Ultimately and most important, the combination of theory and case analyses are synthesized into a prospective approach to stakeholder management that organizations may use during strategic planning.     

Does the Reason Matter? Variations in Childlessness Concerns Among U.S. Women

Does the reason why women have no children matter with regard to level of childlessness concerns? Reasons include biomedical barriers, situational barriers, delaying motherhood, and choosing to be childfree. The concept of “childlessness concerns” captures the idea that holidays and family gatherings are difficult because of not having children or feeling left out or sad that others have children. Life course and identity theories guided the structural equation model analyses of a representative sample of 1,180 U.S. women without children from the National Survey of Fertility Barriers. The results indicated that women with the least control over pregnancy, those with biomedical barriers, had the highest childlessness concerns. As hypothesized, the association between reasons and childlessness concerns was mediated by the identity‐relevant measure, importance of motherhood. Contrary to the authors' hypothesis, the association was not mediated by social messages to have children. Thus, it is primarily involuntarily childless women who have high childlessness concerns.     

Advances in monitoring and evaluation in low- and middle-income countries

Data to inform and improve health care systems in low- and middle-income countries (LMICs) has been facilitated by the development of monitoring and evaluation (M&E) systems. The drivers of change in M&E systems over the last 50 years have included a series of health concerns that have animated global donors (e.g., family planning, vaccination campaigns, and HIV/AIDS); the data requirements of donors; improved national economies enabling LMICs to invest more in M&E systems; and rapid advances in digital technologies. Progress has included the training and expansion of an M&E workforce, the creation of systems for data collection and use, and processes for assessing and ensuring data quality. Controversies have included the development of disease-specific systems that do not coordinate with each other, and a growing burden on health care deliverers to collect data for a proliferating number of health and process indicators. Digital technologies offer the promise of real time data and quick adaptation but also raise ethical and privacy concerns. The desire for speed can cast large-scale evaluations, considered by some to be the gold standard, in an unfavorable light as slow and expensive. Accordingly, there is a growing demand for speedy evaluations that rely on routine health information systems and privately collected “big data” from electronic health records and social media.     

Cognitive behavioural psychotherapy intervention in childhood sexual abuse: identifying new directions from the literature

The short‐ and long‐term consequences of childhood sexual abuse have been extensively reported. However, for many years there has been an absence of psychological conceptual frameworks for understanding and treating abuse trauma symptoms. This paper reviews a number of outcome studies for the treatment of child sexual abuse where a post‐traumatic stress disorder (PTSD) conceptualization was used to plan treatment interventions. The paper concludes that, contrary to some concerns expressed by clinicians, sexually abused children and their non‐abusing carers can signi?cantly bene?t from cognitive behavioural interventions which use reliving and confrontation of the abusive experience. Notwithstanding this, there is a need for further controlled outcome research of cognitive behavioural interventions using reliving techniques to explore how and why these interventions help in reducing abuse‐related PTSD symptoms. Copyright © 2004 John Wiley & Sons, Ltd.     

Competency-based program evaluation: A contingency approach

What types and levels of professional competency should an evaluator have? Should requisite competencies differ depending on the nature of an evaluation? Can a practical competency assessment approach be developed for use in educating highly qualified evaluation professionals? This article addresses these concerns by presenting a contingency model of evaluation competencies. Four broad categories of competency — policy analysis, administrative, interpersonal /personal, and technical — are identified along with three different levels or criteria of acceptable performance. Then several features of the evaluation context, including the evaluation type, the phase and the evaluator role, are individually analyzed to determine the required competencies implied by each. Based on this, a contingency model is developed that postulates requisite competency types and levels depending on a combination of contextual features. The article concludes that the model can usefully serve as a heuristic or organizing mechanism for assessing evaluation contexts and orienting the education of professional evaluators.     

Beyond “Just Saying No”

Summary

How can women deal with unwanted sexual advances from male dating partners in ways that are effective and that, at least initially, take the men's feelings into account? In Study 1,354 under graduate men watched videotapes in which a woman either did or did not openly communicate early during a date that she did not want to do more than kiss. Open communication decreased men's ratings of how much she wanted petting and intercourse, how likely they would be to attempt these behaviors with her, and how “led on” they would feel if they attempted these behaviors and she refused. In Study 2, 424 undergraduate men were presented with 28 responses women could make to a man's sexual advances. They rated each on its effectiveness in getting them to stop their advances and its effect on the relationship. Women can use this information when responding to unwanted sexual advances, taking into account the relative importance of stopping the advance and maintaining the relationship.     

The 90's

Gender differences in AIDS-related heterosexual concerns and sexual behavior with new sexual partners, with an emphasis on condom use and subjective condom experiences, were assessed by a questionnaire survey of middleclass bar patrons, on location, in New York City. Patrons were asked about their number of sexual partners, the extent of their AIDS-related womes and behavioral responses to such concerns, as well as their use of condoms in different sexual situations and their subjective condom experiences. Most people report that AIDS-related concerns have affected their behavior in some way, primarily in the increased use of condoms. Condom use varies according to type of relationship and type of sexual act and results generally in more peace of mind, but less sexual enjoyment. Peace of mind strongly predicts condom use during casual sex for both genders. In terms of gender differences, women worry about AIDS with new sexual partners more than men do and they tend to limit their number of partners more. Women appreciate the use of condoms more than men do, most likely because erection and ejaculatory concerns are fundamental aspects of men's, but not women's, condom experiences. "Worrying about AIDS" predicts condom use during casual sex for men, but not women. More men than women had a condom with them when surveyed.     

Rural homelessness: its effect on healthcare access,healthcare outcomes,mobility, and perspectives of novel technologies

Rural homelessness is an undeniable public health issue that is understudied in the research literature. The purpose of this study was to determine the sociodemographics, physical and mental health status, barriers to access to care, and perspectives on potential technological advances of homeless individuals. A structured 45–90?min interview was utilized to gather demographic, physical health, mental health, mobility, and technology use data from a sample of 75 homeless individuals within three shelters in three micropolitan Nebraska cities. Individuals in this region were more likely to be white, unmarried, and mobile who have various physical and mental health disorders. Adherence to treatment of mental health disorders ranged from 43–60 percent. This population had increased employment, access to healthcare services, and use of technology than predicted. Leaders from all over the country can use these data to help improve state and local efforts to better cater to this vulnerable population's needs.     

Influences of landscape and lifestyle on home energy consumption

Rapid urbanization coupled with concerns about global climate change has renewed interest in energy conservation and carbon dioxide emissions reduction. Urban residential energy consumption is a valuable place to start reducing emissions, and urban tree planting programs have been both proposed and utilized as an energy conservation mechanism. Home energy savings associated with urban trees are often quantified using models because of the many complex interactions among variables that can influence home energy use. However, recent empirical analyses have found that energy savings associated with trees may be minimal relative to other important factors like building characteristics and human behaviors. We surveyed 176 residents from four neighborhoods in Raleigh, NC with varying socio-economic characteristics to assess relationships between summer energy usage, tree cover, homeowner behavior, and building characteristics. As hypothesized, we found that building characteristics, demographics, and human behaviors were all significant variables in describing the variability in summertime home energy usage. Although, total percent tree cover 18?m around the home did not affect summertime energy use, the number of trees in the NE and NW quadrants around each household did predict home energy use. These results indicate that planting trees may not be a successful strategy for reducing energy use from the residential sector in the heavily forested Southeast; rather efforts should target conservation and efficiency.     

Problems and prospects of measurement in the study of culture

What is the role of measurement in the sociology of culture and how can we sort out the complexities that distinguish qualitative from quantitative approaches to this domain? In this article, we compare the issues and concerns of contemporary scholars who work on matters of culture with the writings of a group of scholars who had prepared papers for a special symposium on scientific measurement held at the annual meeting of the American Association for the Advancement of Science (AAAS) back in 1956. We focus on three issues—the recurring need to reinvent measurement (as illustrated by the career of the psychologist S.S. Stevens), the linkage between qualitative and quantitative methods of analysis (as articulated in the writings of the sociologist Paul Lazarsfeld), and the assertion (by philosophers Ernst Cassirer and Peter Caws) that theorizing necessarily precedes measuring. We review a number of important advances in the way that measurement is theorized and implemented in the sociology of culture and we also point to a number of enduring dilemmas and conundrums that continue to occupy researchers in the field today.     

Automated decision-making: Toward a people-centred approach

Recently, automated decision-making (ADM) has been increasingly introduced in for example, the public sector potentially ensuring efficiency and more just decision-making. The increasing use of ADM has been reflected by a growing interest by scholarly research. While initially mainly researchers within law and computer sciences engaged with ADM, there has also been a growing engagement by social science and humanities-oriented researchers. This article traces the emergence and evolution of ADM research beyond computer sciences and engineering with a specific focus on social sciences and humanities by identifying central concerns and methods while outlining a stable baseline for future research. Based on a systematic mapping of publications, we outline the contours of ADM as an area of research engaging with an emerging empirical phenomenon. Drawing on findings from the mapping, we discuss ways ahead for ADM research as part of the subfield of digital sociology and suggest that sociological media and communication studies have a crucial role to play in developing future research avenues. Drawing on advances made in audience research, we suggest a radically contextualized and people-centered approach to ADM. Such an approach would help to develop ADM and ground it alongside people's divergent capabilities and contextual arrangements.     

Environment,Security, and Terrorism in the Trinational Frontier of the Southern Cone

This article analyzes the transformations of notions of governmentality, security, and sovereignty behind recent processes of securitization in the trinational frontier of the Southern Cone, which encompasses the cities of Puerto Iguaz? (Argentina), Ciudad del Este (Paraguay), and Foz do Igua?? (Brazil). It examines how early concerns with security that were primarily focused on the territorial integrity of nation-states have been replaced with security concerns of a more global nature, which call into question established mechanisms of control, particularly those related to the defense of national borders. It examines how environmental concerns are increasingly becoming conflated with other current forms of securitization such as terrorism, popular unrest, and narcotraffic and it analyzes devastating effects of these processes on peoples of the South, particularly the poor.     

Critical Perspectives on Crime and Social Harm: Toward a Criminology of Human Rights

Using Sutherland’s conceptualization of white‐collar crime as a significant point of departure, this article explores recent attempts to theorize crime and social harm from a critical criminological perspective. Arguing that the development of this approach is inextricably linked to theoretical and methodological concerns that strike at the very foundation of criminology as a discipline of study, I show how advances in state and corporate crime literature have advanced the field of criminology. Ultimately I argue that contemporary mainstream criminology, which tends to focus solely on the analysis of traditional ‘street’ crime, has failed to bring within its criminological purview those actions which have the greatest potential for causing significant human suffering.     

OPR and its corruption of “publics”: A critique

This paper advances existing critiques of the organization-public relationship (OPR) research tradition by explicating the poor ontological conceptualization of publics in OPR research as well as related methodological concerns. The authors critically analyze the publics and OPR literature, furthering past criticisms and raising new questions about the heuristic value of OPR research. The paper points out three major weaknesses of the OPR tradition in its use of publics: (1) serious vacillation in terms resulting in conceptual inconsistencies, (2) inappropriate operationalization of variables and the use of probability sampling, and (3) a lack of insightful context and inclusion of relationship factors in OPR studies, to which publics are inextricably bound. The critique cautions scholars engaged in OPR research to improve their literature reviews and to enlarge their methodologies beyond a narrow scope of relational variables, which are theoretically fragile if not devoid of research value. Finally, the critique suggests the importance of conceptualizing publics in ways that acknowledge their agency.     

The ‘compliant’, the ‘pacified’ and the ‘rebel’: experiences with Swiss disability insurance

Switzerland’s social policies in the field of disability have been significantly reshaped over the last two decades by reducing the number of allowances awarded and by increasing the recourse to vocational rehabilitation measures. What stances do individuals who experience the implementation of these policies adopt? What kind of tests are they subjected to? How can we explain the posture they adopt – be it ‘compliant’, ‘pacified’ or ‘rebellious’ – when facing the (re)assignations of their identity and professional status? Drawing on interviews conducted with individuals who have recently been involved in programmes set up by Swiss disability insurance, we highlight their uncertainties and concerns relating to their place in society, as well as their reactions to disability insurance’s interventions.     

Reflexive Research Ethics for Environmental Health and Justice: Academics and Movement-Building

Community-engaged research on environmental problems has reshaped researcher-participant relationships, academic-community interaction, and the role of community partners in human subjects protection and ethical oversight. We draw on our own and others' research collaborations with environmental health and justice social movement organizations to discuss the ethical concerns that emerge in community-engaged research. In this paper we introduce the concept of reflexive research ethics: ethical guidelines and decision-making principles that depend on continual reflexivity concerning the relationships between researchers and participants. Seeing ethics in this way can help scientists conduct research that simultaneously achieves a high level of professional conduct and protects the rights, well-being, and autonomy of both researchers and the multiple publics affected by research. We highlight our research with community-based organizations in Massachusetts, California, and Alaska, and discuss the potential impacts of the community or social movement on the research process and the potential impacts of research on community or social movement goals. We conclude by discussing ways in which the ethical concerns that surface in community-engaged research have led to advances in ethical research practices. This type of work raises ethical questions whose answers are broadly relevant for social movement, environmental, and public health scholars.     

Some things in life can’t be ‘Googled:’ A narrative synthesis of three key questions in outdoor education.

In countries worldwide, Outdoor Education (OE) offers rich possibilities for learning. OE has been researched for many decades; however the field lacks an integrating framework for its different historical, geographical and disciplinary conceptualisations. The outcomes of OE programmes are well documented and appear diverse, yet also have common attributes suggesting there is scope for unifying approaches. Although substantive barriers to the conduct of OE programmes have been identified, these have seldom been synthesised. This paper offers a narrative review of the literature addressing three key questions designed to look rearward at where OE has come from: (i) how is OE conceptualised, and what theoretical models have been used in OE? (ii) what evidence exists regarding the effectiveness of OE programmes? (iii) what are the barriers to conducting OE programmes? The paper then advances onward with an integrated framework for reconceptualising OE and providing insights into how the field may be strengthened and augmented.20124     

Role Induction in Career Counseling

Many vocational psychologists advocate addressing career as well as personal concerns in career counseling. However, some clients may have inappropriate expectations toward career counseling and may not be prepared or want to discuss personal issues. This study examined whether perceptions of the career counseling process could be modified with the use of role induction. Results indicated that, whereas role induction was associated with perceptions of students' own career concerns, gender was a strong influence in perceptions of counseling overall and in the stigma associated with a holistic perspective on career counseling.     

The limits of multiculturalism in elder care services

Over the past decade, policymakers and practitioners in the field of aging have been increasingly challenged to develop appropriate health and social services for elders from diverse ethnic communities. This has largely resulted from concerns regarding the significant barriers to care faced by disenfranchised elders. However, advances in the articulation of multicultural practice and policy dealing with ethnic communities have focused almost exclusively on developing competency skills based on individual communication and understanding between formal service providers and clients rather than on exposing and altering institutional structures and power relations marked by racism. Indeed, antiracist agendas are rarely articulated in gerontological settings. This article reports on some of the central findings of a qualitative institutional ethnographic study on health care access among ethnic elderly women. It addresses the question of how multicultural programs and policies operate in elder care services and how they are experienced by ethnic elderly female clients and their service providers.