Perceived discrimination and early substance abuse among American Indian children

This study investigated internalizing and externalizing symptoms as potential mediators of the relationship between perceived discrimination and early substance abuse among 195 American Indian 5 through 8 graders from three reservations that share a common culture (e.g., language, spiritual beliefs, and traditional practices) in the upper Midwest. The findings indicated that, although perceived discrimination contributed significantly to internalizing symptoms among the adolescents, internalizing symptoms were unrelated to early substance abuse. Rather, the effects of perceived discrimination on early substance abuse were mediated by adolescent anger and delinquent behaviors. The results are discussed in terms of the consequences of perceived discrimination on the development of American Indian early adolescents.     

Feedback from participants and leaders in an intervention program: the 1997-1998 opening doors process evaluation

Parents, students, and program leaders involved in an in-school drug prevention program called Opening Doors were assessed for their perceptions of the efficacy of the program. In general, the feedback indicated a very high program satisfaction level from respondents with parents indicating the highest level satisfaction (92%). Areas for improvement ranged from: parent attendance, invitation process, increased support from schools, and increasing awareness of scheduling and time involvement by leaders and school administration based on program leader feedback as well as invitation process and program duration from the parents (e.g., 37% thought the program was too short). Student satisfaction may be predicted from the perceived impact of the program on significant relationships (e.g., with peers and family) as well as affective reactions to the program (e.g., enjoyment of the program). Finally, a school-level analysis indicated that the application of the Opening Doors Program in different schools was provided uniformly.     

Developing culturally competent marriage and family therapists: guidelines for working with Hispanic families

As the Hispanic population of the United States continues to grow, so will the need for therapists who have been trained to work with Hispanic families. This content analysis of the available treatment literature generated several specific guidelines that can be used in training and evaluating culturally competent therapists. Guidelines included: Use family therapy, act as advocate for the family, assess immigration experience, assess acculturation, respect father, interview family subsystems separately, do not force changes, provide concrete suggestions, and warmly engage the family. Empirical and conceptual support for each guideline is discussed and several conclusions are made regarding culturally competent therapy with Hispanic families.     

Coach your physicians to care,listen and connect with patients

Developing strong physician/patient relationships isn't easy when doctors are pressed for time, forced to see more patients and overburdened with paperwork. Yet, successful organizations realize that the physician/patient relationship is the most valuable asset for the hospital or practice. Learn ways to cultivate the relationship and make it grow even stronger.     

Social status and fertility: A study of a town and three villages in Northwestern Iran

Summary Studies of the relationship between social status and fertility in developing societies have shown diverse results. This study suggests that such findings result in part from problems in the conceptualization of social stratification and social status. In developing societies such as Iran the differentiation of modern and traditional cultural (and occupational) groups within social classes has resulted in the emergence of a dual hierarchy. Measures of social status must therefore reflect these conceptually distinct hierarchies, rather than be limited to linear scales. Figures from a study in a town and three villages in northwest Iran undertaken in 1973 are analyzed. Findings indicate that for women in towns, as social status increases within both traditional and modern occupational hierarchies (husband's occupation) and as measured by income, education and index of modern items, there is a general and almost monotonic decrease in the number of living children, children ever-born, and ideal number of children, with an increase in age at marriage and contraceptive use. The social and cultural homogeneity of the village sample is reflected in the relatively small variations in fertility-related behaviour and attitudes; however, fertility differences between landed and landless villages appear similar to the pattern found in the urban samples. The differences in the fertility behaviour of village and urban women of similar income and educational status indicate that fertility behaviour is related partially to class and partially to status distinctions between urban and rural communities.     

Educational efforts in the implementation of rural family planning programs in East Pakistan

The pilot family planning studies reported in this paper were conducted in a rural area adjacent to the city of Dacca in East Pakistan. It reports the preliminary findings of action-research in the implementation of educational efforts to reach rural villagers of a developing country.Preliminary analyses of the records identify two significant educational problems: (1) most of the villagers (85-90 percent of the couples) who initially accepted contraceptives do not truly adopt and become continuing users and (2) the continuing users (10-15 percent of the initial users) are generally characterized by large families. (Later data show an even lower percentage of continuing users.)The field activities in the development of various educational approaches to family planning are described. Three separate geographic areas (from 15,000 to 20,000 population) were each approached in a different way, varying in the number and educational qualifications of the workers and in the degree of involvement of village leadership. Preliminary analyses of field records indicate that these variations of approach apparently have little effect on the percentage of the population willing to accept contraceptive supplies.It is the opinion of the writers that more intensive educational efforts are necessary at the village level to develop social support for continuing use of contraception and to gain adoption of contraception by younger married couples primarily for spacing of births.The impact of introduction of the IUCD in populations where condoms and foam tablets have been available for one to two years has also been reported. Preliminary findings indicate that the IUCD encourages adoption by previous non-users and may increase the over-all percentage of contraceptive users.     

Cultural aspects of bipolar disorder: Interpersonal meaning for clients & psychiatric nurses

Bipolar disorder is a complicated mental illness to diagnose and treat. The symptoms of the disorder cause a multitude of fluctuations in mood and behavior, affecting the way individuals function and interact with others on a daily basis. Individuals diagnosed with bipolar disorder experience symptoms within a framework that is grounded in their cultural beliefs, values, and norms. Culture is a complex and personal biopsychosocial phenomenon that provides meaning within life for an individual, a group, or a community. It is essential that psychiatric-mental health (PMH) nurses understand the role of culture and integrate this knowledge into the biopsychosocial care of clients. The development and maintenance of the interpersonal therapeutic relationship between PMH nurses and their clients requires the use of a cultural framework, which refers to the connection of culture and cultural competence. The purposes of this article are to define culture and the process of cultural competence, provide a brief overview of bipolar disorder, propose the use of a cultural framework for bipolar disorder, and discuss the implications for PMH nurses who care for culturally and ethnically diverse clients.     

Confronting the disruptive physician

Ignoring disruptive behavior is no longer an option in today's changing health care environment. Competition and managed care have caused more organizations to deal with the disruptive physician, rather than look the other way as many did in years past. But it's not an easy task, possibly the toughest of your management career. How should you confront a disruptive physician? By having clearly stated expectations for physician behavior and policies in place for dealing with problem physicians, organizations have a context from which to address the situation.     

Constitutional guarantees to health care in Spain

This analysis of the Spanish health care system is one in a series of such studies undertaken by the author, following a grid of factors that influence the delivery and financing of health care. The purpose of the national analyses is to facilitate a comparison of the United States' and other health care systems in terms of anticipated reform of the U.S. system. Analyses of the U.S. and nine other national systems are included in a book that has just been published by the College. Spain and nine additional countries will be studied in a book due for publication later this year. A final book with ten additional national analyses will appear in 1996.