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.     

“No Matter What I Do They Still Want Their Family”: Stressors for African American Grandparents and Other Relatives

Grandparents and other relatives increasingly assume the role of primary caregiver to minor children. This study interviewed family members caring for children whose parents were not available due to parental incarceration, other involvement in the criminal justice system, and substance abuse-related issues. Interviews with 25 African American women examined the impact of caregiving including stress and depression. Stress included caregiver issues related to finances, time allocation, care responsibilities, and concerns about the absent parent, as well as issues specific to the children related to school concerns, child behavior, and emotional problems. These stresses were examined along with caregiver depression scores using the Center for Epidemiological Studies Depression Scale, which indicated more depression related to caregiver illnesses, older caregivers, and care for older and a larger number of children. This study suggests that caring for these children is both challenging and stressful, and caregivers are at risk for depression and other mental health concerns. Health and service providers should carefully assess the needs of caregivers when determining the needs of families where children are under care of nonparental relatives. Family-based services are needed that include caregiver supports as well as support for children.     

The use of mental health care,psychotropic drugs and social services by divorced people: does informal support matter?

This study compares the mental health care, psychotropic drugs and social service use of divorced people (re-partnered or single) with that of married people. This paper questions whether the availability of informal support facilitates or substitutes for formal care seeking. Data from the Divorce in Flanders survey of 2009–2010 are used. Logistic regression analyses are performed separately for women (N = 3450) and men (N = 3020). Greater use of mental health care, psychotropic drugs and social services by single divorced men is explained by their higher need for care, while divorced women (especially single divorced) more frequently contact a general practitioner (GP), a psychiatrist, or a psychologist, regardless of their mental health, socio-economic background and informal support. Women who have support from non-family members are more inclined to use social services and to contact a GP, while support from family members is only positively related to GP consultations. With regard to men, informal support from non-family members positively influences each type of formal care seeking. Our results suggest that non-family members (and only among women, family members as well) can provide help and advice about seeking professional mental health care and social services, but they do not have an influence on psychotropic drug use.     

Alternative prenatal care interventions to alleviate Black–White maternal/infant health disparities

This paper attempts to forward the maternal health literature that critiques standard prenatal care in the United States by drawing on intersectionality, medicalization, and fundamental causation theories. We argue that these theories deepen our understanding of the maternal health experiences of Black women and can help explain why alternative prenatal care interventions have value for Black pregnant women. Alternative models of prenatal care, which include the use of midwives, doulas, and group prenatal care, are associated with equal or better health outcomes for infants and mothers compared to the standard prenatal model in the United States. We begin by drawing on these sociological perspectives to identify gaps in the maternal health literature that is critical of standard biomedical maternal health approaches. We then go on to describe select alternative methods of prenatal care and then provide a summary of the epidemiological literature as it relates to sociodemographic trends in usage and the relative effectiveness of alternative models compared to standard care. We conclude by arguing that a joint, critical application of these three theories can help scholars explain the utility of alternative interventions for African American maternal/infant health and can inform policies that aim to alleviate Black–White maternal/infant health disparities.     

Social profile,maternal depression and welfare concerns in clients of health visitors and social workers: a comparative study

Research into the practice of health visitors and child care social workers with depressed mothers is limited. This is surprising in view of the known relationship between motherhood and depression, and the association also between child care problems and maternal depression. The study described below is the first which seeks to compare health visitor and child care social work clients/service users in relation to the issue of maternal depression. In particular, it seeks to compare the extent to which maternal depression is a feature of the work of social workers and health visitors, the relationship between maternal depression and the social composition of different client groups, the relationship between maternal depression and welfare concerns—particularly child abuse—and the extent to which such concerns lead to referral from health visitors to social workers. The research shows: (1) interesting similarities between the depressed health visitor clients and social work clients as a whole; (2) the importance of low income and absence of support in the ‘progression’ from health visitor to social work clients status; and (3) an alarming emerging gap in services provided for severely disadvantaged families with child and family care problems.     

The ethnophysiology and folk dietetics of pregnancy: a case study from South India

The contingency between notions of ethnophysiology and the folk dietetics of pregnancy are examined in a region of South India. Attention is focused on lay perceptions of essential body processes and health concerns during pregnancy. Preventive and promotive health strategies employed during pregnancy by the rural poor which involve diet are considered. The tendency for rural South Indian women to prefer smaller babies and the relationship of this preference to dietary behavior are considered in relation to both concepts of the appropriate quality and quantity of food to eat during pregnancy and the concepts of baby space and baby strength. Nutritional ramifications of alternative food consumption patterns are considered. The importance of understanding indigenous health concerns and notions of ethnophysiology when introducing public health programs is highlighted by a discussion of why many pregnant women are reluctant to comply with iron sulfate, tetanus toxoid, and vitamin therapy as currently presented by primary health care staff.     

Disabled Women and Reproductive Rights

Both the women's and disability rights movements have paid scant attention to the concerns of disabled women, especially involving sexuality, reproductive freedom and mothering. Although their concerns may seem opposite of the women's movement's primary agenda, they are based on the same position: women must not be defined solely by biological characteristics and have the right to make decisions about their bodies and lives. Disabled feminists often support 'reproductive rights', but also have different perspectives on abortion and reproductive technologies than non-disabled feminists. The literature indicates that the reproductive rights of disabled women are constrained by: the assumption that disabled women are asexual; lack of reproductive health care, contraception, and sexuality information; and, social resistance to reproduction and mothering among disabled women. Disabled women are at risk for a range of undesirable outcomes, including coercive sterilization, abortion or loss of child custody.     

Vitamins, herbs, and supplements: tools of empowerment

1. Consumers who elect to use natural products are electing to do more than simply use a product. Their choice is an act of self-empowerment. 2. Education is necessary because these products most often are not being obtained in a professional, consultative setting but rather in chain discount department stores and supermarkets. 3. If consumers choose to address their health concerns using a natural-based treatment plan, consultation with a health care practitioner who shares this shift in perspective and who follows the literature is important. 4. A paradigm shift could be on the health care horizon, which when complete would make herbs and other natural products part of mainstream health care practice.     

Affects of unease: mother–infant separation among professional Indonesian women working in Singapore

The extent of systemic forms of mother–child separation has received insufficient attention in research on migrant families. In this article, I explore the little‐studied phenomenon of mother–infant separation among professional women migrants. I draw from in‐depth interviews with Indonesian professional women working in Singapore who have lived apart from their infant children to pursue work and education. Narratives of separation illustrate a complex transnational network of care built around an availability of support offered by spouses or extended kin. Women experience unease about separation, which emerges in how they talk about their absent infants. Mothers articulate ambivalence about the potential cost of their decisions, positing infants as able to pass judgement on them, with potential rejection and disengagement causing them potent concerns. The unease of these mothers moderates claims that transnational separation is readily managed and highlights the ambiguity embedded in an increasingly common form of transnational mother–child separation.     

Age, ethnicity, and use of complementary and alternative medicine in health self-management

Drawing on models of health self-management, we develop hypotheses that age and ethnicity will modify associations among indicators ofpoor health and use of complementary and alternative medicine. These hypotheses are evaluated using the 2002 National Health Interview Survey with the Alternative Health Supplement. Results produced partial support for hypotheses that the effects of ailments on use of complementary and alternative medicine differ by age. Results suggest that ailments such as bodily pain, chronic conditions, and functional impairment are associated with use of complementary and alternative medicine among midlife and younger adults, but these associations are generally attenuated among older adults. Hypothesized ethnic differences received weak support. These findings suggest that different interpretations of ailments and appropriate responses may explain why complementary and alternative medicine is used by fewer older adults. The results also highlight the significance of social and cultural factors in understanding patterns of complementary and alternative medicine use in the adult population.     

Residential group care workers' recognition of depression: Assessment of mental health literacy using clinical vignettes

BackgroundResidential group-care workers have a critical role to play in recognizing mental health problems amongst children in their care. However, little is known about the extent to which workers recognize and respond to mental health and behavioral concerns.MethodA sample of 124 residential group care workers completed an online survey in which vignettes of children experiencing either internalized or externalized symptoms of depression and ‘typical’ behavior were presented. In order to explore aspects of mental health literacy, workers were asked to rate each vignette for severity of a specific mental health concern (adolescent depression), portrayed as internalized or externalized behavior. Ratings of worker confidence and concern for the young person were also obtained.ResultsWorkers were able to recognize the existence of depression in these fictional vignettes. Depression in the presence of externalized behavior was rated as both more severe and more concerning than depression accompanied by internalized behaviors. Furthermore, workers had greater confidence in endorsing the presence of a mental health issue when accompanied by externalized behavior compared to an internalized presentation.ConclusionsResidential group-care workers are able to recognize the existence of depression amongst children in their care. Externalized presentation of mental health appears to be more easily recognized by workers and they are also more confident in identifying mental health concern when it is accompanied by externalized, compared with internalized behaviors. The implications for training and support of residential group care workers are discussed.     

Associations Between Psychological,Physical, and Sexual Intimate Partner Violence and Health Outcomes Among Women Veteran VA Patients

Women veterans experience high rates of lifetime intimate partner violence (IPV) and suffer a variety of trauma-related health conditions. The purpose of this study was to identify health status and health risk behaviors associated with experiences of psychological, physical, or sexual IPV among women veterans receiving care at a Veterans Affairs (VA) medical center. We conducted surveys with 249 women veteran patients and examined health factors associated with each form of violence. Sexual IPV victimization had the most pronounced associations with adverse health. In multivariate analysis, controlling for age, race, and income, women veterans who experienced sexual violence victimization were close to or more than three times as likely as those who experienced no IPV to report poor or fair overall health, a diagnosis of post-traumatic stress disorder or depression, bipolar disorder, or anxiety, difficulty sleeping, cigarette smoking, and problem drinking. Those who reported psychological violence only (without physical or sexual violence) also reported greater odds of self-rated poor or fair health. These findings are consistent with findings from studies with non-veteran populations and serve to further identify the unique contributions of sexual IPV to health outcomes. The integrated VA health care system offers opportunities for IPV identification and response including a coordinated team-based care model with social work integrated within primary care.     

Treatment Engagement Using Motivational Interviewing for Low-Income, Ethnically Diverse Mothers with Postpartum Depression

Postpartum depression (PPD) places women, and their children, at risk for many untoward outcomes including lack of responsivity, low self-efficacy, and insecure infant attachment. Especially at risk for untreated PPD are low-income, ethnically diverse mothers. Seeking and accepting treatment for depression may be impeded by the many psychological and social barriers that mothers may bring with them. Obstacles might include a lack of resources (e.g., lack of transportation or child care), stigma, distrust, and a lack of knowledge about stress and depression. To reduce these and other barriers to treatment, this paper points to the value of utilizing motivational interviewing techniques to engage and retain low-income, ethnically diverse women for treatment of PPD. Following a review of PPD and related barriers to treatment, a case study is presented with example dialogue. The suggestions for practice represent starting points for effective engagement of women in any number of treatments provided by social and health services settings. With federal mandates to screen for depression in many settings and to provide treatment, using motivational interviewing may be an effective prelude to treatment adherence.     

Considering child care and parenting needs in Veterans Affairs mental health services

Child care and parenting needs of adults with mental illness are of growing concern, especially among those seeking Department of Veterans Affairs (VA) mental health services. One area of interest concerns the possible benefits that on-site child care could have for improving veterans’ access to VA mental health care. Child care programs are currently being piloted at the VA for the first time, although the need for them has not been evaluated. We conducted a brief survey of a convenience sample of 147 veterans (132 men, 15 women) seeking mental health care at outpatient clinics and/or at a psychiatric rehabilitation center at one VA. Participants were asked about their attitudes and experiences regarding child care and parenting support at the VA. Of the 52 (35.4%) participants who responded and had children under 18, the majority of both men and women surveyed agreed that the VA should offer child care services and that they would use child care services at the VA if it were available. These results are based on a small sample of participants, but they may contribute to ongoing discussion and efforts to develop “family-friendly” mental health services.     

Gender, household labor, and psychological distress: the impact of the amount and division of housework.

Using a national longitudinal survey of a representative sample of 1,256 adults, I assess the impact of the amount of household labor performed and its division within the household on men's and women's depression levels, adjusting for prior mental health status. I test two alternative explanations of the contributions of household labor and the division of household labor to gender differences in depression: differential exposure and differential vulnerability. The results indicate that men's lower contributions to household labor explain part of the gender difference in depression. Inequity in the division of household labor has a greater impact on distress than does the amount of household labor. Employment status moderates the effect of the division of labor on depression. Among those who describe themselves as keeping house, depression was lowest for those who performed 79.8 percent of housework. In contrast, for those employed full-time the minimum level of depression occurs at 45.8 percent of the household labor. Men report performing 42.3 percent of the housework in their homes compared to 68.1 percent reported by women. Thus, on average women are performing household labor beyond the point of maximum psychological benefit, whereas men are not. Social support mediates the effects of the division of household labor. The only gender difference in effects occurred among those who are married, for whom social support was associated with lower levels of depression for women than men.     

Complementary Practices and Herbal Healing

Abstract

As a means of achieving increased levels of health and Wellness, complementary methods such as alternative approaches and medicinal preparations are being utilized to supplement or replace what has been viewed as traditional health care practice. To promote effective, efficient, and comprehensive helping relationships, social workers need to be cognizant that clients are using these methods and products, and how this use can affect the health care services they receive. This article identifies and discusses some of the basic types of alternative practices, herbal preparations, essential oils, and flower essences; as well as, the problems that can result from inadequate knowledge of the use or misuse of these products. In conclusion, emphasis is placed on increasing social work awareness and education in this area.     

Alternative Worldviews and the Utilization of Conventional and Complementary Medicine*

We use the Midlife in the United States (MIDUS) database and an expanded Anderson model that incorporates health beliefs, including sacred worldviews as predisposing factors, to explore conventional and complementary and alternative medical (CAM) service use. Findings are that health care need, especially the number of chronic conditions is positively associated with both conventional and CAM services use. However, net of need, health beliefs and sacred worldviews differentiate CAM users versus nonusers or the number of different CAM practices that are used. Higher self‐rated spirituality is associated with being a CAM user and, if a user, with adopting a wider range of practices. Individuals with higher self‐rated religiosity are not more or less likely to be CAM users but adopt significantly fewer techniques, if users. We discuss the attraction to very different faces of health care, on the basis of religiosity, spirituality, and other health beliefs, with implications for policymakers and care providers.     

Cost, convenience and quality in child care demand

This paper presents an economic analysis of child care use by employed women with children under six years of age. Observations of actual child care choices are used to estimate the relative importance assigned by parents to cost, convenience and quality in child care. On the basis of these estimates, the chances that each type of child care arrangement will be used are predicted. Projections of child care use are presented for a range of potential costs, travel times, child-staff ratios, and family circumstances. This study is unique in employing information not only on child care arrangements already used, but also on the alternative arrangements available to individual families. The child care data were collected in a 1977 survey of New York City employees. Overall, the model correctly predicted 78% of the observed child care choices. The results of the analysis show strong effects of cost in child care choice. The demand for day care centers is especially sensitive to user cost; if centers were available free of charge, for example, there is a 65% chance that the average single working mother in the sample would use one. Travel time and child-staff ratios have small but statistically significant effects on the choice of child care arrangements. Weekend work schedules and presence of infants are also important choice factors. Once costs are accounted for, family income has no significant effect on the type of child care chosen.     

Risk and protective factors for depression and substance use in an adolescent child welfare sample

Research on the mental health needs of maltreated youth in out-of-home care remains limited. The goal of the current study was to examine two common mental health concerns (i.e., depression, substance use) among 122 12-15 year olds in out-of-home placements. Specifically, we investigated potential risk and protective factors among socio-demographic, maltreatment, youth, family, and community variables. We relied on data collected through the AAR-C2, a Canadian needs assessment and outcome monitoring tool. Approximately 4 in 10 (39.2%) youth endorsed at least one mental health problem, which we defined as the youth scoring at least one standard deviation above the sample mean for the depression items and the youth indicating the presence of alcohol and/or substance use over the past year. Almost 1 in 10 (8.3%) reported struggling with both mental health issues. Results from logistic regressions indicated that adolescent females were at higher risk of experiencing depression than males, and increasing age was associated with increased risk for substance use. Turning to protective factors, results indicated that the greater the perceived quality of the youth-caregiver relationship, the lower the risk for mental health difficulties (i.e., depression, substance use). Moreover, participation in extracurricular activities appeared to protect youth against depression or substance use. Results imply that the youth-caregiver relationship and involvement in extracurricular activities are important areas to consider to promote the well-being of maltreated youth in out-of-home care.