The effect of professional socialisation on midwives' practice

This article discusses the influence that professional socialisation can have on midwifery practice. Differences in beliefs and practices regarding the oral intake of labouring women were the basis for this paper's discussion. Midwives should be aware of the problems that may be caused by the socialisation processes experienced during the training and subsequent working life of a midwife which aim to procure obedience and unquestioning conformity. These attributes diminish the ability of midwives to challenge traditional practices and to make decisions based on the available research evidence and the preferences of women in their care. Basing practice on tradition or practice conventions rather than a formal guideline or an evidence-based policy may expose a midwife to potential litigation should there be an adverse event.     

Weighing the success of a national Alzheimer's disease service demonstration

As the need for long-term care services within the United States has grown dramatically, Congress has consistently deflected the primary responsibility for such care to state governments, local organizations, and, ultimately, the family. This paper examines the impact of the Alzheimer's Disease Demonstration Grants to States (ADDGS) program, a small federally funded initiative within the context of this trend. Although the demonstration can be deemed a huge success relative to the goals of creating new services for an underserved target population, questions are raised about the merits of the program relative to the exploding need for an effective network of long-term care services.     

A semi‐Markov model for binary longitudinal responses subject to misclassification

The authors propose a two‐state continuous‐time semi‐Markov model for an unobservable alternating binary process. Another process is observed at discrete time points that may misclassify the true state of the process of interest. To estimate the model's parameters, the authors propose a minimum Pearson chi‐square type estimating approach based on approximated joint probabilities when the true process is in equilibrium. Three consecutive observations are required to have sufficient degrees of freedom to perform estimation. The methodology is demonstrated on parasitic infection data with exponential and gamma sojourn time distributions.     

A theoretical analysis of antecedents of young couples’ fertility decisions and outcomes

Longitudinal survey data from 509 couples who at Time 1 interview had recently married or had their first child did not support the hypothesis that demographic factors influence fertility intentions, decisions, and outcomes only indirectly through their effects on attitudes and motivations. Husbands’ and wives’ attitudes exerted reciprocal influence on one another. However, while husbands’ sex-role traditionalism and motivation for parenthood strongly influenced wives’ traditionalism and motivation in the case of recently married couples, this pattern was reversed for riew parents. Birth control use was directly affected by wives’ fertility intentions, but not by husbands’ intentions. Difficulties in examining couple interaction variables such as relative power and the possible limitations of fitting these data to a complex theoretical model using LISREL are discussed.     

Correlates of African American female adolescent offenders 3, 4-Methylenedioxymethamphetamine (MDMA or “Ecstasy”) use and sexually transmitted infection morbidity

Abstract

The current study was designed to determine the extent to which self-reported ecstasy use in a population of juvenile adolescent detainees in a southern state is associated with high-risk health behaviors pertaining to sexually transmitted infection (STI) symptomology and past history of STI occurrence. Participants were 764 African American females extracted from an overall sample of 2,260 juvenile offenders housed at selected Youth Development Campuses in the state of Georgia. Significance tests were conducted using univariate logistic regressions to examine the independent associations of participant’s self-reported ecstasy use and dichotomized HIV risk behavior correlates and history of having a prior STI before the most recent incarceration Participants who reported ecstasy use prior to incarceration were 1.7 (OR = 1.68, 95% CI = 0.78–3.64) and 1.8 times (OR = 1.87, 95% CI = 1.24–2.81) more likely respectively to indicate having had genital warts or chlamydia, and were more than 1.5 times (OR = 2.21, 95% CI = 0.83–5.44) and two times more likely to report having had gonorrhea or herpes, accordingly. Prevention programs for adolescent offender populations should develop interventions that target adolescents’ substance use behavior as a function of STI risk taking as well as being culturally competent to deal specifically with these problem behaviors.     

Land fragmentation under rapid urbanization: A cross-site analysis of Southwestern cities

Explosive population growth and increasing demand for rural homes and lifestyles fueled exurbanization and urbanization in the western USA over the past decades. Using National Land Cover Data we analyzed land fragmentation trends from 1992 to 2001 in five southwestern cities associated with Long Term Ecological Research (LTER) sites. We observed two general fragmentation trends: expansion of the urbanized area leading to fragmentation in the exurban and peri-urban regions and decreased fragmentation associated with infill in the previously developed urban areas. We identified three fragmentation patterns, riparian, polycentric, and monocentric, that reflect the recent western experience with growth and urbanization. From the literature and local expert opinion, we identified five relevant drivers ?C water provisioning, population dynamics, transportation, topography, and institutions ?C that shape land use decision-making and fragmentation in the southwest. In order to assess the relative importance of each driver on urbanization, we linked historical site-specific driver information obtained through literature reviews and archival analyses to the observed fragmentation patterns. Our work highlights the importance of understanding land use decision-making drivers in concert and throughout time, as historic decisions leave legacies on landscapes that continue to affect land form and function, a process often forgotten in a region and era of blinding change.     

Irish child sexual abuse victims attending a specialist centre

We profiled a cohort of CSA cases referred for assessment to a specialist child sexual abuse (CSA) centre in a national paediatric hospital in Ireland. Historical and clinical data were drawn from records of 171 cases. The majority of cases were referred by social workers following purposeful disclosure of CSA. Three quarters of the cases were female with a mean age of 9 years. They were from a wide spectrum of socioeconomic groups and many had suffered a range of family adversities. In most cases, the abuse involved masturbation of the child by the abuser. Almost all of the perpetrators were male with a mean age of 28 years and in 60% of cases extrafamilial abuse had occurred. In 23% of cases, the perpetrator had a history of previous sexual offending. Anxiety was the most common emotional problem before disclosure and after disclosure the most common emotional problem was guilt. Before disclosure school refusal was the most common behavioural problem and after disclosure fighting was the most prevalent behavioural difficulty. The most common factors supporting the credibility of CSA allegations were labile mood, the child's ability to differentiate fact from fantasy and a detailed disclosure of contextual details. More adolescents showed deterioration in schoolwork after disclosure and for more pre school children clinginess following disclosure was a significant emotional problem. More primary school aged children were abused by perpetrators who had abused a number of children. For children abused by such perpetrators, vaginal intercourse was less common. Vaginal intercourse was more common in 6–11‐year‐old victims and those who were abused on a daily basis. The threat that disclosure posed to the integrity of the family structure was more often a factor hindering disclosure in victims abused by father figures and abused very frequently. Copyright © 2003 John Wiley & Sons, Ltd.     

A comparison of two programmes for victims of child sexual abuse: a treatment outcome study

This study aimed to evaluate the comparative effectiveness of individual therapy and combined individual and group therapy in the treatment of the psychological sequelae of child sexual abuse. The Child Behaviour Checklist (CBCL), the Youth Self Report form (YSR), the Children's Depression Inventory (CDI) and the Trauma Symptom Checklist for Children (TSCC) were administered before treatment and 6 months later to a group of 20 young people who participated in individual therapy (IT) programmes and to a group of 18 young people who participated in programmes that involved combined individual and group therapy (IGT). For both types of programmes, statistically significant improvement occurred on the following scales: the total problems, internalizing problems, externalizing problems, withdrawn, somatic complaints, anxious/depressed, social problems, attention problems and aggressive behaviour problems CBCL scales; the total depression, interpersonal problems and anhedonia CDI scales; and the depression and anger TSCC scales. The only scale for which one therapy programme led to greater improvement than another was the CDI ineffectiveness scale. The IGT programme led to a reduction in the mean CDI ineffectiveness score, whereas a slight increase in the mean ineffectiveness score occurred in the IT group. There were no significant differences in the rates of clinically significant improvement associated with the two treatments and no major differences between cases who improved and those that did not improve over the course of therapy. From this study, it may be concluded that after 6 months, individual therapy and combined individual and group therapy were equally effective in the treatment of the psychological sequelae of child sexual abuse. Copyright © 2002 John Wiley & Sons, Ltd.     

A non-parametric test for umbrella alternatives based on ranked-set sampling

A test is proposed that extends the Chen-Wolfe (1990) test for umbrella alternatives with an unknown peak to use with ranked-set samples data. This follows from ideas in Bohn & Wolfe (1992), Magel (1994), and Hartlaub & Wolfe (1999). Critical values are simulated for the proposed test based on ranked-set samples of size 2 for 3, 4 and 5 populations. A power study is conducted comparing the proposed test using ranked-set samples with the Chen-Wolfe and Mack-Wolfe tests using simple random samples. Results are given.     

Correlates of Human Immunodeficiency Virus/Sexually Transmitted Infection (HIV/STI) Testing and Disclosure Among HIV-Negative Collegiate Men Who Have Sex With Men

Abstract

Objective: To determine the extent to which personal, behavioral, and environmental factors are associated with human immunodeficiency virus/sexually transmitted infection (HIV/STI) testing and disclosure. Participants: Nine hundred thirty HIV-negative collegiate men who have sex with men (MSM) who completed an online survey about alcohol use and sexual behavior. Methods: Correlates of testing and disclosure significant in bivariate analyses (p < .05) were grouped into personal, behavioral, or environmental factors and entered into multivariable logistic regression models. Results: About half of participants tested for HIV (51.9%) and for STIs (45.8%) at least annually. Over half (57.8%) of participants always/almost always discussed HIV status with new sex partners; 61.1% with new unprotected sex partners. Personal and behavioral factors (age and outness) explained differences in testing, and the behavioral factor (routine testing) explained differences in disclosure. Conclusions: Collegiate MSM should be supported in coming out, encouraged to engage in routine testing, and counseled on discussing HIV/STI status with potential sex partners.