Comparing Self-Rated Health, Satisfaction and Quality of Life Scores Between Diabetics and Others Living in The Bella Coola Valley

Objective: To investigate the relative effect that diabetes has on self-rated health, satisfaction with various specific domains of life, and satisfaction with quality of life operationalized as happiness, satisfaction with life as a whole, and satisfaction with overall quality of life. Design: Mixed methods – mailed survey and chart review. Study Population: All people aged 17 years or older, residing in the Bella Coola Valley in September 2001 and having a chart at the Bella Coola Medical Clinic. Main outcome measures: Self-rated health, self-rated stress, rating of self-care received, global life satisfaction (Life as whole; Overall standard of living; Overall quality of life; and Overall happiness); and satisfaction with various domains of life. Results: A total of 968 useable surveys were returned for a response rate of 56 (968/1734). Age was negatively related to General Health, but positively related to Life Satisfaction. Not being of Aboriginal descent was positively related to all of the four global health indicators and to Subjective Well-Being. After accounting for age, race, and weight, we found that diabetics report significantly poorer self-rated health, and lower satisfaction with health scores compared to people without diabetes. Participants with diabetes who were the least compliant with their treatment regimens rated their current health significantly lower than those who were the most compliant. People with diabetes were, however, no more likely to be unhappy or dissatisfied with their lives as a whole or with the overall quality of their lives compared to people without diabetes. Among people with diabetes, however, those who used insulin did report significantly less satisfaction with the overall quality of their lives than those who didn’t use insulin. Conclusion: Diabetics understand they have poorer health than others, but they do not have poorer global life satisfaction scores. This may explain why it is difficult to get diabetics to adopt behaviours which may lower their quality of life – e.g., diet plans, lose weight, engage in exercise programs, or take medications.     

The impact of discernment counseling on individuals who decide to divorce: experiences of post‐divorce communication and coparenting

Discernment counseling is designed to help couples considering divorce arrive at a greater sense of clarity and confidence in their decision making about the future of their marriage. Possible outcomes include making no change to the marriage, divorcing, or attempting reconciliation through couples therapy. To date, no research has been done on whether or not discernment counseling helps couples who decide to divorce with their post‐divorce family life (i.e., coparenting). We surveyed 11 people (from male–female couples) and conducted in‐depth interviews with eight who had undergone discernment counseling and subsequently divorced to see what impact discernment counseling had on their post‐divorce coparenting relationship. We analyzed the data from a phenomenological perspective. Respondents described their discernment counseling experience as helpful for achieving clarity and honesty in the divorce decision‐making process, they shared their appreciation for the structure of the intervention, and indicated that it led to a greater coparental cooperation post‐divorce.     

Women's perspective of maternity care in Cambodia

BackgroundConsideration of the needs of pregnant women and their ability and willingness to attend maternal services and pay for them is central to the provision of accessible and acceptable maternal care. Women's satisfaction with maternal services is poorly understood in many developing countries, including Cambodia in South East Asia. The objective of this study was to investigate women's perceptions and experiences of private and public skilled birth attendants, including midwives, during childbirth in Cambodia.MethodsA qualitative design using a naturalistic inquiry approach was undertaken to seek sensitive personal issue. Thirty individual in-depth interviews were conducted with women who had recently given birth at private and public health facilities in one province in Cambodia. Data were analysed using a thematic approach.FindingsWomen's choice of health facility was influenced by their perceptions of safety and staff attitudes. Reported barriers to the effective utilisation of public maternity services were costs associated with the birth, staff attitudes and a lack of supportive care during labour and in the postpartum period. Although private health care is more expensive than public health care, some women reported a preference for private birth attendants as they perceived them to provide safer and more supportive care in labour.ConclusionWomen expect, but do not always receive humane, professional, supportive and respectful treatment from public skilled birth attendants. While the removal of unexpected costs and geographical barriers are important to increasing public maternity care and service utilisation, improvements in maternity services should focus on addressing provider attitudes and enhancing communication skills during labour, birth and the immediate postpartum period.     

What Does Parental Divorce or Marital Separation Mean for Adolescents? A Scoping Review of North American Literature

Parental divorce in North America and the resulting changes to the traditional family unit as seen in current academic literature are troubling. These changes are especially worrisome as they relate to adolescent life and development. This scoping review examines the past 11 years of North American English language literature concerning adolescents who have experienced parental divorce. Literature was taken from health-related databases using the search terms adolescent and divorce. The resulting articles were analyzed and pared down to 53 papers that adhered to predetermined criteria. Analysis revealed trends in how the studies are conducted as well as seven themes throughout the literature. The authors suggest future research directions based on the trends, themes, and found knowledge gaps in the recent literature.     

Attitudes About Remarriage in Malta

This study investigated the attitudes about remarriage of married and previously married Maltese people. Respondents were selected using stratified random sampling; 810 men and 1,196 women answered a questionnaire by means of computer-assisted telephone interviewing. The majority (67.4%) of respondents did not consider remarriage. Remarriage was more likely to be considered by respondents who were younger, previously married, nonparents, had children who were not all born within marriage, and were of higher socioeconomic status. The study highlights the differences in attitude according to gender and marital status. The fact that pro-remarriage attitudes were endorsed by 32.6% of respondents and that these were more likely to come from nontraditional family forms suggests that family life in Malta is no longer dictated by normative social imperatives. The need for the legal protection of families headed by cohabiting partners is highlighted.     

Practical Ways Psychotherapy Can Support Physical Healthcare Experiences for Male Survivors of Childhood Sexual Abuse

This pilot study was conducted to examine older child molestation victims' self-report of their long-term psychological adjustment at least 12 months after the date of their initial clinic evaluation. Female participants were assesed using the Piers-Harris Children's Self-Concept Scale, Children's Depression Inventory, and the Hopelessness Scale which were also administered during their first evaluation. T-ratios revealed that scores on all measures, including five of the six Piers-Harris subscales showed significant improvement. The high rate of noncompliance associated with this population is also discussed in terms of removal from the home, type of abuse, and age of the perpetrator.     

INGO Accountability Deficits: The Imperatives for Further Reform

Numerous attempts have been made to remedy the accountability deficits of international non-governmental organisations (INGOs). The ‘first wave’ of accountability reforms was largely driven by powerful stakeholders such as donors and governments. An accountability culture subsequently emerged that reflected the preferences of these agents, rather than the responsibility of the INGO to abide by its mission. The ‘second wave’ of reforms acknowledged that INGOs incur a broad range of accountability responsibilities to beneficiaries, members, staff, and peer organisations. These measures have not been sufficient to promote reflective practice driven by discourse with those closest to the mission. It is argued that there is a need for a ‘third wave’ of accountability reforms, which reinforces the responsibilities of INGOs towards the communities that they purport to serve. INGOs should embrace a critically reflective accountability culture that addresses ways in which communication with their so-called ‘beneficiaries’ is distorted by unequal power relations.

Se han hecho numerosos intentos para remediar los déficits en la rendición de cuentas de las organizaciones no gubernamentales internacionales (INGOs, por sus siglas en inglés). La ‘primera ola’ de reformas a la rendición de cuentas se habían manejado por protagonistas poderosos tales como donantes y gobiernos. Una cultura de rendición de cuentas surgió subsecuentemente, que reflejaba las preferencias de estos agentes, en vez de la responsabilidad de la INGO de atenerse a su misión. La ‘segunda ola’ de reformas reconoce que los INGOs incurren en un rango amplio de responsabilidades de rendición de cuentas a los beneficiarios, miembros, personal y organizaciones paralelas. Estas medidas no han sido suficientes para promover una práctica reflexiva impulsada por discusiones con aquellos más cercanos a la misión. Se sostiene que hay una necesidad por una ‘tercera ola’ de reformas de rendición de cuentas, que refuerza las responsabilidades de los INGOs hacia las comunidades a las que pretenden servir. Los INGOs deberían abarcar una cultura de rendición de cuentas críticamente reflexiva que trata maneras en las que la comunicación con sus así llamados ‘beneficiarios’ está distorsionada por las relaciones de poderes desiguales.

人们进行了多种努力以图弥补国际非政府组织（INGOs）的责任赤字。责任改革的“第一次浪潮”主要由权力很大的诸如捐助者和政府等各种利害攸关方所驱动。随之兴起的责任文化反映了这些机构的偏好,却不是国际非政府组织遵命的责任。改革的“第二次浪潮”承认,对受益人、成员、工作人员和同行组织,INGOs 招致广泛的责任。这些措施尚不足以促进那些由最接近使命的话语所驱动的反思实践。有人主张“第三次浪潮”责任改革的必要性,此种改革可以加强INGOs针对他们声称服务的各种社区的责任。INGOs 应该乐意接受批评性反思的责任文化。这种文化致力于各种方式与方法。而在这些方式方法中,与所谓的“受益者”进行的沟通因不平等的权力关系而扭曲。

????? ??????? ????? ??????? ???? ?????? ?? ???????? ???? ???????? ??????? ??? ????????. ????? "?????? ??????" ?? ??????? ????? ???????? ?? ?????? ????? ?? ??? ????? ????? ???? ????? ??? ?????? ??????? ?????????. ????? ???? ???? ????? ?????? ?????? ?? ??????? ??? ????? ??????? ????? ?? ??????? ???????? ??????? ??? ???????? ?? ???????? ???????. ????? "?????? ???????" ?? ????????? ??? ???????? ??????? ??? ???????? ????? ?????? ????? ?? ???????? ???????? ???? ????????? ?? ??? ????????? ????????? ????????? ????????? ????????. ??? ??? ??? ????????? ?????? ?????? ??????? ?????? ?????? ?????? ?? ?????? ?????? ??? ???? ??????? ???????. ????? ??? ???? ??? ????? ??? ??? ???? ??? "???? ?????" ?? ????????? ?? ???? ????????? ???? ???????? ???????? ??????? ??? ???????? ???? ????????? ???? ?????? ?? ?????? ??? ????????. ?????? ??? ???????? ??????? ??? ???????? ?? ????? ????? ???????? ???????? ????? ????? ???? ?? ?????? ????? ??????? ?? ?? ????? ????? ??? "?????????"? ???? ???? ??? ??????? ?? ?????? ?????.

?? ??????(INGOs)?? ??? ??? ???? ?? ?? ???? ?????. ??? ??? ‘? ?? ??’? ??? ???? ??? ?? ??? ?? ???? ??? ?????. ??? ???? INGOs? ????? ??? ????? ??? ???? ??? ??? ??? ????. ??? ??? ‘? ?? ??’? INGOs? ??? ?? ??, ??, ??? ?? ????? ??? ??? ??? ?? ???? ????. ??? ???? ??? ?? ??? ????? ??? ??? ???? ??? ?????? ????? ???. ??? ??? ‘? ?? ??’? ????, ??? INGOs? ??? ?? ???? ?? ????? ?? ??? ???? ?? ??? ??? ???. INGOs? ??? ‘????’?? ??? ???? ?? ??? ??? ???? ??? ?? ???? ???? ???? ??? ??? ????? ?? ??? ??.

Были предприняты многочисленные попытки исправить дефицит ответственности международных неправительственных организаций (МНПО). “Первую волну” реформ ответственности в основном вели влиятельные заинтересованные лица, такие как дарители и правительства. Культура ответственности впоследствии появилась, отражая предпочтения этих агентов, а не обязанность МНПО соблюдать свою миссию. “Вторая волна” реформ показала, что МНПО несет широкий диапазон обязанностей и ответственности перед бенефициариями, персоналом и аналогичными организациями. Эти меры не были достаточны, чтобы продвинуть рефлексивную практику, которая обусловлена дискурсом с самыми близкими к миссии. Утверждается, что есть потребность в “третьей волне” реформ ответственности, которая укрепит обязанности МНПО перед сообществами, которым они призваны служить. МНПО должны критически охватить рефлексивную культуру ответственности, которая обращается к способам, где коммуникация с так называемыми “бенефициантами” искажена неравным соотношением сил.     

Increasing the use of alcohol screening and brief intervention in New Zealand

New Zealand has high rates of acute alcohol-related harm relative to chronic harm, and when compared with other countries. Acute harm is typically caused by binge drinking. New Zealand alcohol use surveys consistently find that about 20–25% of adult drinkers binge drink. There is substantial overseas evidence that alcohol screening and brief intervention (SBI) in primary health care is effective and cost-effective for reducing alcohol harm among binge drinkers. However, while there is also growing evidence that alcohol SBI can successfully be implemented in New Zealand, the approach has been significantly under-utilised. This article provides a brief overview of New Zealand research that supports a case for increasing the use of alcohol SBI in primary health care. It also highlights that when looking to successfully implement alcohol SBI in other settings, it is important to ensure that the intervention is simple and purpose-built for both the setting and recipient.     

Managing the science in the presence of financial conflict of interest

ABSTRACT

We consider the question of why (primarily) and how (secondarily) to perform scientific oversight of research performed by investigators with a financial conflict of interest (COI). One way to frame the trade-off of having investigators with financial COI participate in research is through a decision rule: “Our institution is willing for financially conflicted investigators to participate in research around their intellectual property if (a) the science is likely to be significantly better with their participation (or if other significant benefits accrue); and (b) the COI can be adequately managed”.

A key component of COI management is the demonstration that the underlying science is sufficiently rigorous and transparent, and in turn, a scientific oversight plan is a key element of that demonstration. Scientific oversight plans should be proactively generated, by individuals (i.e., scientific reviewers) who are independent and expert, and they should assess the rigor and transparency of the research, in a fashion which is fair and efficient.

Abbreviations: COI: conflict of interest; SOP: scientific oversight plan     

Contested milieux: Small firms,unionization, and the provision of protective structures

Three trends in the workplace point to the importance of considering work relations as well as governance structures for the development of protective benefits such as pensions. The increasing concentration of employment growth in smaller firms, the general decline of unionization, and the changing composition of the work force constitute the new exigencies of worker-employer contracts. The 1983 Current Population Survey Pension Supplement is used in conjunction with certification data from the National Labor Relations Board to examine the interaction between firm size and the influence, as opposed to the prevalence, of unionization in the provision of pensions. Unionization is found to be more influential in the provision of pensions for workers in small firms despite the established prevalence of unionization in larger firms. The implications of these trends for labor market theory are discussed.This is a revised version of papers that were presented at the annual meetings of the Gerontological Society of America, November 1988, and the American Sociological Association, August 1989.