Caring for vulnerable populations: curricula in U.S. internal medicine residencies

The Accreditation Council for Graduate Medical Education (ACGME) encourages internal medicine training programs to include specific curricula devoted to health care issues of vulnerable populations. Our aim was to determine the prevalence of curricula involving selected vulnerable populations among U.S. Internal Medicine residencies. We conducted a survey of Program Directors of all US Internal Medicine Residencies assessing whether the program had a curriculum for six vulnerable populations (racial and ethnic minorities, non-English speaking patients, lesbians, gay men, victims of domestic violence and patients with substance abuse problems). Most residencies address substance abuse and victims of domestic violence, while there remains a lack of dedicated teaching on other vulnerable populations, including lesbians, gay men, racial and ethnic minorities and non-English speaking patients.     

Non-surgical cosmetic procedures: older women's perceptions and experiences

This paper analyzes findings from in-depth interviews with 44 women aged 50-70 regarding their perceptions of and experiences with non-surgical cosmetic procedures such as Botox injections, laser hair removal, chemical peels, microdermabrasion, and injectable fillers. While 21 of the women had used a range of non-surgical cosmetic procedures, 23 women had not. The data are discussed in light of feminist theorizing on cosmetic surgery which has tended to ignore the experiences of older women and has been divided in terms of the portrayal of cosmetic surgery as either oppressive or liberating. We found that some of the women used the procedures to increase their physical attractiveness and self-esteem, others viewed the procedures as excessively risky, and still others argued that the procedures stemmed from the social devaluation of later life. Treatments that involved the alteration of the surface of the body tended to be viewed as less risky than the injection of foreign substances into the body.     

Drivers of plant biodiversity and ecosystem service production in home gardens across the Beijing Municipality of China

Home gardens have been recognized as repositories of agricultural biodiversity across the world. The influence of socioeconomics and location-specific factors on urban gardening patterns merits continued study. Using Beijing Municipal Province in China, a rapidly urbanizing region, as a case study, we address two questions: 1) How do biodiversity patterns change between different urbanized regions in Beijing? 2) How do ecosystem services provided by Beijing home gardens change with socioeconomic status and location-based preferences of gardeners? We surveyed 104 home gardens in Beijing Municipal Province for plant biodiversity, abundance, and species ecosystem services (ES) (provisioning or cultural uses). The gardens were distributed across three urbanized regions (suburban, peri-urban, and exurban). We found that species biodiversity and abundance shift according to a hierarchy of need from ornamentals (cultural ES) to edibles (provisioning ES) with increasing distance from Beijing. These trends are related to reduced income, lowered food security, and lack of urban markets in exurban regions. Rarefaction curves indicate ornamental species drive β diversity. Ordination also showed a shift in species composition with increasing isolation from the city; Suburban and exurban gardens were the most different, while peri-urban gardens were similar to both others. Only exurban gardens had a positive relationship between species and area. High edible cover and high species density indicates that demand for edibles in exurban regions may be higher than space constraints allows. Our study better quantifies species biodiversity patterns in Beijing, and can inform urban planners about the value and usefulness of home garden space.     

Assessment of the Dose–Response Relationship Between Folate Exposure and Cognitive Impairment: Synthesizing Data from Documented Studies

The dose–response relationship between folate levels and cognitive impairment among individuals with vitamin B12 deficiency is an essential component of a risk-benefit analysis approach to regulatory and policy recommendations regarding folic acid fortification. Epidemiological studies provide data that are potentially useful for addressing this research question, but the lack of analysis and reporting of data in a manner suitable for dose–response purposes hinders the application of the traditional evidence synthesis process. This study aimed to estimate a quantitative dose–response relationship between folate exposure and the risk of cognitive impairment among older adults with vitamin B12 deficiency using “probabilistic meta-analysis,” a novel approach for synthesizing data from observational studies. Second-order multistage regression was identified as the best-fit model for the association between the probability of cognitive impairment and serum folate levels based on data generated by randomly sampling probabilistic distributions with parameters estimated based on summarized information reported in relevant publications. The findings indicate a “J-shape” effect of serum folate levels on the occurrence of cognitive impairment. In particular, an excessive level of folate exposure is predicted to be associated with a higher risk of cognitive impairment, albeit with greater uncertainty than the association between low folate exposure and cognitive impairment. This study directly contributes to the development of a practical solution to synthesize observational evidence for dose–response assessment purposes, which will help strengthen future nutritional risk assessments for the purpose of informing decisions on nutrient fortification in food.     

The Determinants of Economic Growth Versus Genuine Progress in South Korea

This paper examines whether the drivers of economic growth are the same as those for genuine progress in the case of South Korea. Using data covering the period 1970–2005, the paper first constructs a Genuine Progress Indicator (GPI). An empirical model is then specified and estimated using growth in GDP per capita and growth in the GPI per capita as dependent variables. Results indicate that while physical capital, research and development, exports, and inflation are all important in determining growth in GDP per capita, only physical capital is a driver of genuine progress. These findings highlight the need for policymakers to identify and target other determinants of genuine progress to improve the well-being of South Koreans, rather than focus attention on traditional sources of economic growth.     

‘Management Standards’ work-related stress in the UK: practical development

Research commissioned for the UK's Health & Safety Executive (HSE) supports the view that a preventative, risk-assessment based approach would be more effective than case-based methods in achieving a nationwide reduction in work-related stress. The background to this approach is described and discussed in a companion paper in this issue (Mackay, Cousins, Kelly, Lee, & McCaig, ). The present paper describes the development of HSE's new stress Management Standards—which offer organizations continuous improvement through a three-phase stress preventative process—and the development of a supporting ‘Indicator Tool’ (a two-phase questionnaire to assess employee perceptions of working conditions). The Management Standards comprise a series of ‘states to be achieved’, which are statements of good practice in six key stressor areas: demands, control, support, relationships, role and organizational change. For each stressor area there is also a ‘platform statement’ that outlines the main aims to be achieved by the organization. This statement may include a target percentage of employees finding that the organization meets the standard: this matter will be settled after the standards have been assessed in a public consultation campaign. To use the new process, an organization's state can first be assessed using the Indicator Tool; liaising with workers in focus groups enables a further exploration of issues raised; finally, there may be formulation of interventions and subsequent review. It is not intended that the standards will be legally enforceable. HSE's aim is that they and the associated methodology will enable organizations to effectively tackle work-related stress, and subsequently reduce both its incidence and prevalence.     

Introduction to the special issue on welfare conditionality in Australia

Conditionality in Australia’s welfare state has sustained a significant academic critique, including the critique published in this journal. In this Special Issue of the Australian Journal of Social Issues, we contribute to the existing critical literature on welfare conditionality. This Special Issue aimed to provide empirical scrutiny into welfare reform and conditionality in Australia. The articles extend our understanding of welfare conditionality’s underpinnings and its lived effects. These case studies illuminate the aspects of welfare conditionality that have not received enough attention: the role of technology, the question of mobility, the relationship with housing and the little thought given to the state’s role in mutual obligation. What is clear is that the individualisation of structural problems is not just a theoretical and political misstep ripe for critique, but leads to the formulation of policies that impact marginalised people’s capacity to shape life on their own terms. Through different empirical foci, all papers in this Special Issue demonstrate how welfare conditionality is put forward as a solution to address the consequences of structural disadvantage.     

The Portrayal of Children's Mental Health and Developmental Issues from 1890 to 1920 in Mass Print Magazines in North America

Children's mental health and development issues are considered a significant concern today. A century and more ago children's mental health and developmental disorders were likely understood differently. This paper examines the portrayal of children's mental health and developmental disorders in all 41 accessible articles on the topic indexed in the Reader's Guide to Periodical Literature from 1890 to 1920. It focuses on these three decades as a time of fundamental economic, political and social transition before the first text in Child Psychiatry was published and the first professorship in the field established. It was also before the beginning of the influential child guidance movement. In particular, the research asks (i) what were the ‘disorders’ discussed and of what were they said to consist?, (ii) what was said to cause them? and (iii) what was thought best to be done about them?