Management,Competition and Professional Practice: Medicine and the Marketplace

Within the context of the creation of the internal market for health care, the paper examines the role of clinical directors, that is doctors who have retained their professional clinical positions whilst at the same time assumed roles as managers within increasingly well-defined corporate organizations providing health care. This represents considerable change from previous contexts in which doctors could always contract out of difficult managerial decisions. The role of clinical director is examined in terms of its own directorate and its involvement in contracting, co-operation and competition both within its own corporate organization and within the wider market place for health. Key issues are raised for the individuals and organization by these changes, they are discussed in terms of time, succession, managing colleagues, financial and human resources, market behaviour, support and terms of reference. These changes occasion wider discussion in terms of the challenge of coping with future demands for innovation, changes in the distribution of power within an emerging market for health care and the relationship among health care organizations, professionals and lay clients.     

The Physical Self-Perceptions of Rural Lesbians and Heterosexual Women

Lesbians are underrepresented in women's health research. Research exploring lesbians in rural environments is virtually nonexistent. The current study adds to the knowledge base of lesbian health and explores the perceptions of body image, fitness, and health for both lesbians and heterosexual women in rural communities. Findings from exploratory analyses indicated that both groups of women are significantly overweight. However, lesbians exercised more times per week than heterosexual women. Results demonstrated that lesbians with college educations had more positive body image and fitness self-perceptions, whereas heterosexual women with college educations had less positive body image and fitness self-perceptions. Findings have implications for direct practice with lesbians in physical and mental health service settings.     

Social networks and immigration stress among first‐generation Mandarin‐speaking Chinese immigrants in Los Angeles

This study examined relationships between social networks and immigration stress among first‐generation Chinese immigrants. Using data from a larger study of health behavior among first‐generation Mandarin/English‐speaking immigrants residing in the Los Angeles metropolitan area (N = 1,183), this study found that Chinese immigrants living closer to immediate family and maintaining larger social networks experienced lower immigration stress. Unexpectedly, immigrants with larger family sizes and who participated in voluntary associations (e.g., religious, alumni, and nationality associations) reported increased immigration stress. The findings suggest that practitioners need to be cautious of a possible downside in designing interventions to expand social networks among immigrant clients. The study is especially important in the context of a rapidly increasing immigrant population from Mainland China to the USA. Key Practitioner Message: ● Working with immigration families should incorporate assessment of their social network; ● Interventions designed to facilitate supportive social networks should differentiate different social network ties; ● Different social network ties may affect the stress level of immigrants differently.     

(Re)Conceptualizing Family Communication: Applying Deetz’s Conceptual Frameworks within the Field of Family Communication

This article explores trends in metatheoretical approaches to research within family communication studies. In particular, in this work I critique the traditional philosophical perspective, arguing that the isolation of paradigms, and the positioning of research as post-positivist or interpretivist or critical, limits the production and capacity of knowledge, and therefore the field as a whole. As a response, I put forth Deetz’s (2001) discursive orientations as a more inclusive and comprehensive perspective from which family communication research should be conducted, with the crux of the argument being that the fluid nature of Deetz’s orientations positions knowledge as existing between and within, therefore allowing research to be both/and instead of either/or, and subsequently producing knowledge that is inherently more complete and inclusive.     

Caught in a “Bad Romance”? Reconsidering the Negative Association Between Sociosexuality and Relationship Functioning

Sociosexuality refers to individual differences in interest and willingness to engage in sexual activity without an emotional connection. Unrestricted sociosexuality is associated with a greater likelihood of infidelity and with poorer relationship quality. However, previous research has failed to examine relationship-specific characteristics that may moderate these findings. Two studies of romantically involved adults examined whether relationship commitment and different relationship agreement types moderate the associations between unrestricted sociosexuality and infidelity. Study 1 (N = 300) showed that individuals in consensual monogamous (CM) relationships with extradyadic sex (EDS) experiences were more sociosexually unrestricted than individuals without such experiences. The positive association between unrestricted sociosexuality and EDS emerged only for less, but not more, committed individuals. Study 2 (N = 270) replicated these results. Furthermore, results showed that individuals in consensual nonmonogamous relationships (CNM) relationships were the most sociosexually unrestricted, but no differences emerged in relationship commitment or satisfaction, when compared to individuals in CM relationships without prior EDS. Individuals in CM relationship with prior EDS were the least committed and satisfied. The negative association between unrestricted sociosexuality and both relationship quality indicators emerged for all individuals in CM relationships, but it was nonsignificant for individuals in CNM relationships. Implications are discussed.     

A Heart to Learn and Care? Teachers' responses toward special needs children in mainstream schools in Hong Kong

This article examines the problems associated with introducing integrated education into Hong Kong's mainstream schooling system. The research objectives were to examine the experience of teachers in teaching children with special needs in mainstream schools; to examine the attitude of mainstream teachers towards integrated education, and explore whether the differences in perception of difficulties and attitudes are attributable to types of disability and availability of resources. This was achieved through a research strategy utilising a questionnaire survey combined with individual and group interviews. The results demonstrate that there is a clear hierarchy of preference amongst teachers in relation to special needs children. Students with a learning disability and/or behavioural problems pose more challenges to teachers than those with a physical difficulty. Teachers that had both types of special needs children in a class experience more problems in maintaining classroom discipline, have a greater workload and struggle to manage the disparate academic standards amongst students. Teachers in schools with extra funding provisions, teachers trained to teach special needs children, additional counselling resources and specialist support expressed more accepting attitudes towards children with special needs and their admission into mainstream schools. Resource classes did not exert a positive effect on acceptance. More than 70% of questionnaire respondents were supportive of two positive value statements 'realisation of equal opportunities' and 'a good chance for students to interact'. At the same time teachers tended to agree with the statements 'integration was a burden to the schools and teachers' (over 60%) and 'a painful struggle for special students' (48%). Although there is a general normative acceptance of inclusion, the statistical pattern suggests that teachers' attitudes are not static or based solely on ideology.     

Dangerous Liaisons: The Time Is Out of Joint

ABSTRACT

Anne is an older woman, with a history of severe, complex trauma, including abandonment and multiple rounds of sexual abuse, which started in her early childhood and was followed by sexual exploitation in a previous experience of therapy. In this article I discuss her treatment with me in the context of the #MeToo movement and the rest of the current troubling sociopolitical constellation. I argue that when tanks crash into our bedrooms and transform them into battlefields, seismic psychic change occurs: catastrophic or healing or both. I also contemplate the nature of the psychoanalytic contract between patient and therapist, as well as the limits of the psychoanalytic endeavor in the face of massive social and historical trauma, “when the time is out of joint” (Shakespeare, “Hamlet”).     

Mission Possible; Building Social Work Professional Identity through Fieldwork Placements in China

Social work training programmes in China have increased rapidly in the last decade. Their growth mirrors the increase in social problems that China faces as its economy develops and the disparities between rich and poor multiply. There is little recognition either by the government or citizens of the profession of social work and so no clear idea of what it might achieve. Thus the development of social work in China faces many difficulties among which is a dearth of professionally qualified social workers to teach, and to supervise fieldwork placements. This paper discusses a collaborative MSW programme between the University of Hong Kong and Fudan University in Shanghai. It analyses the growth in professional identity of nine students in the programme undertaking their first supervised fieldwork placement in Shanghai. They were asked to write 500‐word statements before and after their placement about their understanding of the role of social workers and their sense of professional identity. An analysis of these statements forms the basis of this article. The article addresses the issue of whether the construction of a professional identity will rest with members of the embryonic profession or with government bureaucrats largely concerned with the maintenance of stability and the management of social change.