Psychiatric unit fall event

Patient falls in psychiatric units may have an impact on patient outcomes. Fall risk assessment among psychiatric patients is an important issue. Gait/balance problems and history of falling are important considerations in assessing psychiatric patients for fall risk.     

Gender and physician-assisted suicide: an analysis of the Kevorkian cases, 1990-1997

This study examines the seventy-five suicide cases Dr. Jack Kevorkian acknowledged assisting during the period between 1990-1997. Although these cases represent a range of regional and occupational backgrounds, a significant majority are women. Most of these individuals had a disabling, chronic, nonterminal-stage illness. In five female cases, the medical examiner found no evidence of disease whatsoever. About half of the women were between the ages of forty-one and sixty, and another third were older adults. Men's conditions were somewhat less likely than women's to be chronic and nonterminal-stage. The main reasons for the hastened death mentioned by both the person and their significant others were having disabilities, being in pain, and fear of being a burden. The predominance of women among Kevorkian's assisted suicides contrasts with national trends in suicide mortality, where men are a clear majority. It is possible that individuals whose death was hastened by Kevorkian are not representative of physician-assisted suicide cases around the country, because of Kevorkian's unique approach. Alternatively, the preponderance of women among Kevorkian's assisted suicides may represent a real phenomenon. One possibility is that, in the United States, assisted suicide is particularly acceptable for women. Individual, interpersonal, social, economic, and cultural factors encouraging assisted suicide in women are examined.     

Psychosocial versus biomedical risk factors in Kevorkian's first forty-seven physician-assisted deaths

This article examines biomedical and psychosocial data on the first forty-seven cases of physician-assisted suicide (PAS) of Kevorkian as collected by means of both a physical autopsy and a preliminary psychological autopsy. The following patterns emerge: 1) The physical condition of these PAS patients was not typical of the conditions that lead to death in the United States. 2) Consistent with the above findings, our pilot data indicate that only 31.1 percent of these patients were terminal. While 73.9 percent were described as reporting pain, only 42.6 percent were revealed at autopsy to have a specific anatomical basis for their pain. However 36 percent were described as depressed, 66 percent as having some disability, and perhaps of key importance, 90 percent expressed a fear of dependency. Most important, our pilot data suggest the possibility of large gender differences, since 3) 68.1 percent of these forty-seven PAS's are women and only 31.9 percent are men. This represents the reverse of the gender pattern for completed suicides in the United States in 1995, resembling instead the approximate pattern for unsuccessful suicide attempts. 4) Approximately 75 percent of both men and women in the above sample were described as reporting pain. Men were almost twice as likely to have had an anatomical basis for the pain and three times as likely to be terminal. Our pilot data indicate PAS women are more likely to be described as depressed and twice as likely to have had a history of previous unsuccessful suicide attempts. 5) Kevorkian's patients were older than the typical unaided suicides in America. Reported pain decreases with age as does depression; however anatomical basis for pain increases slightly with age, and no age effect emerges for terminality. 6) Approximately two-thirds of those physician-assisted suicides were at middle SES levels. History of disability was the biggest risk factor for the low SES patients and fear of dependency for the high SES patients.     

Effect of the doctor on college students' attitudes toward physician-assisted suicide

Ninety-six students were presented with eighteen different vignettes describing different types of active and passive observed suicide, assisted suicide, and euthanasia. Attitudes regarding the morality and desired legality of each situation were measured. Results indicated that the interaction between the doctor and the patient, and, to a lesser extent, the active or passive nature of the agent of death, were more important than the actual actions of the doctor in allowing or causing death to occur.     

The development of the physicians' end-of-life care attitude scale

The Physicians' End-of-Life Care Attitude Scale (PEAS) was developed as an outcome measure for palliative care education. PEAS assesses the willingness of medical trainees to care for dying patients. Sixty-four Likert-type questions were created on the basis of discussions with focus groups of medical trainees, then administered to sixty-two medical students and residents. Total PEAS scores as well as personal preparation and professional role subscales (where higher scores indicated greater concern) possessed excellent internal consistency and reliability. In addition, there were substantial correlations between PEAS scores and the CA-Dying scale, a measurement of laypersons' fears about interacting with dying persons. Thus, PEAS adequately assesses the unique communication concerns of physicians in training regarding working with dying persons and their families. Correlations between PEAS scores and age were negative, while those who had experienced the death of a loved one had higher PEAS scores than those who did not. This suggests that for some persons, life experiences may lessen difficulties in dealing with dying persons, while for others, personal losses may exacerbate such concerns. The utility of PEAS in evaluating the efficacy of palliative care education as well as its potential to measure medical trainee's willingness to care for the terminally ill is discussed.     

The disruptive physician. A quality of professional life factor.

Medical leaders need to understand that attending to quality of professional life issues includes dealing with the insidious costs and stress associated with disruptive physician behavior. The disruptive physician or professional undermines practice morale, heightens turnover in the organization, steals from productive activities, increases the risks for ineffective or substandard practice, and causes distress among colleagues. Physician executives need to help reduce or prevent this behavior and develop accepted systems in which to manage, confront, and rehabilitate the person labeled "disruptive." Suggested strategies to consider in developing a system include: (1) Defining reasonable and competent interpersonal behavior; (2) educating in interpersonal skills; (3) evaluating interpersonal skills; (4) developing disruptive policy; and (5) assessing, confronting, and rehabilitating.     

The discourse and dimensions of irregularity in post-apartheid South Africa

South Africa's migration policy since 1994 has been described as contradictory and confused. Indeed, there are profound differences of opinion within government and civil society over the best means to deal with what is believed to be a massive and threatening increase in clandestine migration and irregular employment.
Clarity of thought and policy debate has been hampered by an inflammatory discourse which fixates on the issue of numbers, and views all migrants as a problem and threat. Partly this reflects fundamental inadequacies in systems of data collection and analysis, and partly a poor understanding of the causes and character of cross-border migration in Southern Africa.
As a corrective, this article presents an overview of the causes and spatial/sectoral distribution of irregular employment in post-apartheid South Africa, drawing on recent research. It then critically examines efforts to ascertain the dimensions of undocumented migration to South Africa, concluding that the results are fundamentally flawed by the methodologies used. The article then disaggregates irregular migration and assesses current knowledge about each subcategory.
In conclusion, the article argues for a comprehensive labour market survey as the foundation for a coordinated and rational approach to the challenges of irregular migration and employment.     

Homeless mothers and depression: misdirected policy.

This paper is a critique of recent service-intensive shelter programs for homeless mothers and the policies that underlie these shelters. We first document the process by which mental health problems and family homelessness became so closely but mistakenly linked. We then demonstrate empirically that shelter programs for homeless families nonetheless presume that mental health problems are part of the causal nexus of family homelessness and indiscriminately deliver mental health services to homeless mothers. Simultaneously, shelter programs encourage the isolation of their residents from what they presume to be their "problematic" social networks. We show that, while mental health services had little impact on depression levels among homeless mothers, isolation from social networks did increase depression among homeless mothers. Our findings suggest that policy should put more emphasis on rapid reintegration into the community through providing housing, and it should put less emphasis on providing services.     

Gender, social status, and emotional reliance

Past research has suggested the potential importance of considering emotional reliance, a dimension of interpersonal dependence, when addressing social and developmental risk factors for depression. Based on a probability sample of 1,393 adults aged 18-55 residing in Toronto, Canada, this paper addresses gender differences in emotional reliance and the relevance of emotional reliance in explaining the gender-depression association. We also explore link-ages between emotional reliance and status factors. Findings indicate that emotional reliance is significantly related to depression and that women report greater reliance than men, independent of social status factors like marital and parental status, education, income, and occupational prestige. Moreover, the positive association between emotional reliance and depression is greater for women. Several social status factors modify the relationship between gender and emotional reliance. Both education and occupational prestige reduce reliance, and are particularly beneficial in this regard for women. Marriage, on the other hand, increases emotional reliance, especially for men. We offer interpretations of this pattern of findings.