Older lesbians receiving home care: formal and informal dimensions of caregiving

Older lesbians face the triple jeopardy of ageism, sexism, and heterosexism, and their experiences are largely invisible. This qualitative, exploratory study examines the formal and informal caregiving experiences of 20 lesbians, 65 and older, who had utilized home care services due to acute illness or chronic disabilities. Half of those not partnered reported some level of isolation from support networks. Nearly all study participants eventually found home care workers with whom they were satisfied and even quite connected. Practice implications are discussed in context of study participants’ views of how being lesbian affects their aging process and day-to-day lives.     

Postnatal breastfeeding education at one week after childbirth: What are the effects?

Background

The first week after childbirth is a crucial period for exclusive breastfeeding initiation.

Exploring the qualities of midwifery-led continuity of care in Australia (MiLCCA) using the quality maternal and newborn care framework

ProblemMidwifery-led continuity of care has well documented evidence of benefits for mothers and babies, however uptake of these models by Australian maternity services has been slow.BackgroundIt is estimated that only 10% of women have access to midwifery-led continuity of care in Australia. The Quality Maternal Newborn Care (QMNC) Framework has been developed as a way to implement and upscale health systems that meet the needs of childbearing women and their infants. The Framework can be used to explore the qualities of existing maternity services.AimWe aimed to use the QMNC Framework to explore the qualities of midwifery-led continuity of care in two distinct settings in Australia with recommendations for replication of the model in similar settings.MethodsData were collected from services users and service providers via focus groups. Thematic analysis was used to develop initial findings that were then mapped back to the QMNC Framework.FindingsGood quality care was facilitated by Fostering connection, Providing flexibility for women and midwives and Having a sense of choice and control. Barriers to the provision of quality care were: Contested care and Needing more preparation for unexpected outcomes.DiscussionMidwifery-led continuity of carer models shift the power dynamic from a hierarchical one, to one of equality between women and midwives facilitating informed decision making. There are ongoing issues with collaboration between general practice, obstetrics and midwifery. Organisations have a responsibility to address the challenges of contested care and to prepare women for all possible outcomes to ensure women experience the best quality care as described in the framework.ConclusionThe QMNC Framework is a useful tool for exploring the facilitators and barriers to the widespread provision of midwifery-led continuity of care.     

Fertility, child care outside the home, and pay-as-you-go social security

We examine the long-run effects of the pay-as-you-go (PAYG) social security scheme on fertility and welfare of individuals in an overlapping generations model, assuming that child-care services are available in the market. We show that the impact of a tax increase on fertility depends on the relative magnitudes of the standard intergenerational redistribution effect through the social security system, the (implicit) subsidy effect through tax-exemption of child rearing at home, and the price effect through changes in the relative price of market child care, and that if parental child-rearing time is inelastic, a tax cut could bring about a Pareto-improving allocation.

Beliefs and expectations of family and nursing home care among Mexican-origin caregivers

This study examined perceptions of family care, nursing homes, and expectations of future care among 85 Mexican-origin women caregivers, some who lived in Mexico City and some who lived in East Los Angeles, California (East LA). Attitudes of Mexican-born women—living in Mexico City and in East LA—were more similar to each other than those of U.S.-born women. Most caregivers reported a preference for family care and had negative views of institutional care. In addition, despite the negative views about nursing homes, some caregivers expressed a willingness to seek nursing-home care for themselves so as to avoid burdening their children in the future. Findings lend support to the persistence of Mexican cultural values in this sample of Mexican-origin caregiving women, regardless of where they were born.     

Childbearing traditions of Indian women at home and abroad: An integrative literature review

BackgroundThe percentage of overseas-born mothers giving birth in Australia has increased to 31.5% in 2012 and Indian women represent 10% (the highest proportion). It is important for midwives in Australia to be aware of the childbearing traditions of Indian women and how these influence Indian women birthing in Australia.AimTo explore childbearing practices in India and Indian women's experience of giving birth abroad; and to discuss the relevant findings for midwives working with Indian women in Australia.MethodAn integrative literature review was employed. 32 items, including 18 original research articles were thematically reviewed to identify commonly occurring themes relating to Indian women's childbearing traditions.FindingsFive themes relating to traditional childbearing practices of women birthing in India were identified. These themes included diversity and disparity; social context of childbirth and marriage; diet based on Ayurveda; pollution theory and confinement; and finally, rituals and customs.ConclusionIndian women giving birth abroad and by implication in Australia experience a transition to motherhood in a new culture. While adjusting to motherhood, they are also negotiating between their old and new cultural identities. To provide culturally safe care, it is essential that midwives reflect on their own culture while exploring what traditions are important for Indian women.     

Caring together for elderly mothers: a qualitative study of relations between adult daughters and supportive home care workers

This qualitative study examines relationships between adult daughters caring for elderly disabled mothers and the mothers' personal care workers (PCWs) paid directly by the Wisconsin Community Options Program (COP). A subset of a larger study, in these five cases PCWs provide substantial hands on care without substituting for the heavy care also provided by the daughters. Direct payment offers the daughters and workers freedom to schedule around their family obligations and other limits and tailor care to the abilities of all three participants. It also allows the daughter to be the paid provider when she chooses. Expansion of such supportive services could benefit many more low and middle income families.     

Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment

ProblemWhile routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician.AimsTo assess the impact of psychosocial risk, current symptoms and mode of assessment on women’s honesty of disclosure at psychosocial assessment.MethodsLogistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were ‘always honest’ and ‘not always honest’. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk.Findings10.8% (N = 193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR = 1.78, 95%CI: 1.18–2.67, p < 0.01) and lack of social and partner support (aOR = 1.74, 95%CI: 1.16–2.62, p < 0.05; aOR = 2.08, 95%CI: 1.11–3.90, p < 0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest.DiscussionA history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback.ConclusionGreater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.     

城市居家老人生活质量研究——以上海为例

本文针对城市居家老人的需要和特点,从评估城市居家老人生活质量的六个维度即经济状况与消费水平、居住条件与家庭设施、躯体健康与心理健康、社会支持、闲暇生活质量、生活满意度方面入手,深入开发了上海市老年人口状况与意愿跟踪调查数据资料,使用分等级加权评分法综合评估了城市居家老人生活质量以及分性别和年龄的老人生活质量。     

养老院老人的需求与养老机构专业化——对北京市某养老院的个案研究

本文通过对北京市某养老院的个案研究 ,分析了当前中国养老院老人的生活及精神、心理需求。文章指出 ,正是这些需求的出现不断推动着中国养老机构走向专业化的道路。而在提升服务水平 ,迈向专业化的过程中 ,引入社会工作的专业价值与工作手法 ,是中国养老机构拓展生存和发展空间的有效途径     

Affect and cognition in the context of home: The quest for intangibles

The three papers in this special issue represent an important advance in the effort to understand people's attachment to place. Economic factors do not provide an adequate explanation; it is necessary to seek less tangible influences. There are grounds for looking to the physical setting, and especially the natural environment available to residents. Access to other resources may also be important. And group affiliation can impact both cognitive and affective aspects of the attachment process. In terms of future research to better understand these intangibles, it may help to focus on the sense of place, the factors that make an environment psychologically comfortable. Three variables are proposed as researchable facets of the sense of place: (1) legibility, (2) the perception of and preference for the visual environment, and (3) the compatibility of the setting with human purposes.Requests for reprints should be mailed to Dr. Stephen Kaplan, Department of Psychology, Psychological Laboratories, Mason Hall, University of Michigan, Ann Arbor, MI 48109     

The clinical performance and cost-effectiveness of two psychosocial assessment models in maternity care: The Perinatal Integrated Psychosocial Assessment study

ProblemAlthough perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain.AimTo compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA).MethodsWomen attending their first antenatal visit were prospectively recruited to this cohort study. Endorsement of significant depressive symptoms or psychosocial risk generated an ‘at-risk’ flag identifying those needing referral to the Triage Committee. Based on its detailed algorithm, a higher threshold of risk was required to trigger the ‘at-risk’ flag for PIPA than for Usual-Care. Each model’s performance was evaluated using the midwife’s agreement with the ‘at-risk’ flag as the reference standard. Cost-effectiveness was limited to the identification of True Positive and False Positive cases. Staffing costs associated with administering each screening model were quantified using a bottom-up time-in-motion approach.FindingsBoth models performed well at identifying ‘at-risk’ women (sensitivity: Usual-Care 0.82 versus PIPA 0.78). However, the PIPA model was more effective at eliminating False Positives and correctly identifying ‘at-risk’ women (Positive Predictive Value: PIPA 0.69 versus Usual Care 0.41). PIPA was associated with small incremental savings for both True Positives detected and False Positives averted.DiscussionOverall PIPA performed better than Usual-Care as a psychosocial screening model and was a cost-saving and relatively effective approach for detecting True Positives and averting False Positives. These initial findings warrant evaluation of longer-term costs and outcomes of women identified by the models as ‘at-risk’ and ‘not at-risk’ of perinatal psychosocial morbidity.     

Housing and wealth inequality: Racial-ethnic differences in home equity in the United States

In our study, we took a first step toward broadening our understanding of the sources of both housing and wealth inequality by studying differences in housing equity among blacks, Hispanics, Asians, and non-Hispanic whites in the United States. Using data from the American Housing Survey, we found substantial and significant gaps in housing equity for blacks and Hispanics (but not for Asians) compared with whites, even after we controlled for a wide range of locational, life-cycle, socioeconomic, family, immigrant, and mortgage characteristics. Furthermore, the payoffs to many factors are notably weaker for minority than for white households. This finding is especially consistent across groups for the effects of age, socioeconomic status, and housing-market value. Blacks and Hispanics also uniformly receive less benefit from mortgage and housing characteristics than do whites. These findings lend credence to the burgeoning stratification perspective on wealth and housing inequality that acknowledges the importance of broader social and institutional processes of racial-ethnic stratification that advantage some groups, whites in this case, over others.     

The mommy wars: on the home front and waged abroad

Anne-Marie Slaughter’s Atlantic article “Why Women Still Can’t Have It All,” published in 2012, generated huge response, well beyond what already has become typical in the intensifying mommy wars in the United States. It also drew considerable attention globally. Within one week of publication, Slaughter’s “lament” attracted a million readers. Slaughter’s explanation of why she quit her high powered job, and then Yahoo’s choice of the then-pregnant Marissa Mayer as its new chief executive, provoked another round of mommy wars. The research reported here on how journalists dealt with the controversy compares the US, with its tradition of heated controversy over working mothers and neoliberal opposition to structural supports for families, and Israel, where attention to Slaughter was somewhat surprising, given the presumption in Israel that mothers will work outside the home. Journalistic discourse in both countries tended to frame the work–home conflict as a women’s issue, to be addressed by women journalists, and not men. Moreover, writers tended to address the issue anecdotally, in terms of personal experience but ignoring structural issues and structural solutions and ignoring how solutions for middle-class professional women or women at the “center” may not work for other kinds of women.     

Gay and lesbian youth, emergent identities, and cultural scenes at home and abroad

This introduction opens up the field of studies of gay and lesbian adolescents, both with regard to past and present studies in the research literature, and by allusion to the new studies collected in this issue. Historical and crosscultural elements of the context of the "coming out" process are discussed. Four preconceptions of gay youth are critically examined, regarding their heterosexuality, inversion, stigma, and heterogeneity. The anthropological construct of life crisis "rites of passage" is utilized as a heuristic framework for deconstructing attitudes regarding change and constancy in homosexual adolescents. Aspects of age, sex, class, and related variables related to the form and content of the coming out process are then examined in the United States and other societies. Finally, the social problems of gay youth, AIDS and its impact in particular, are briefly considered. The author concludes with a plea for new and urgent research.     

Development,inequality, health care,and mortality at the older ages: a cross-national analysis

We examine mortality at ages 50 and above in female populations of 38 countries and control for variation in quality of the mortality data. We find that economic development, economic distributional inequality, and basic primary health care have independent cross-national effects on cause of death structures and that these effects are not uniform across the age intervals of interest. As improvements occur in level of living and heath care, age-specific death rates decline except at the oldest ages, at which point they may increase. Our results are interpreted in terms of their relevance for mortality research, theory, and policy.