Alternative and complementary therapies for the menopause

Despite a re-evaluation of risks in recent years, hormone replacement therapy is still surrounded by controversy. Almost 30% of women in a recent survey sought a natural approach to combat climacteric symptoms. Nevertheless, a large proportion of patients felt that they wanted a good safety profile and strong evidence base for treatment. This article seeks to review the evidence supporting non-hormonal approaches to treatment. There is only conflicting evidence at best to support alpha-2 agonists, e.g. clonidine and limited evidence for dihydroepiandrosterone and natural progesterones. There is limited randomized controlled trial data for gabapentin, selective norepinephrine re-uptake inhibitors (SNRIs) and selective serotonin re-uptake inhibitors (SSRIs), many of these studies being related to breast cancer patients. Of the herbal medicinal products, the largest evidence base rests with phytoestrogens. A Cochrane Database review looking at all types of phytoestrogens, e.g. red clover extracts, dietary soya and soya extracts concluded that there was no evidence to support improvement in climacteric symptoms and the meta-analysis of a 178 studies on soy products was inconsistent. Nevertheless, other studies disagree. Mammographic density is not affected by soy or phytoestrogen products and recent in vitro work shows only a weakly proliferative effect of soy isoflavone on breast cancer cells and evidence that soy isoflavone blocks the proliferative effect of estradiol on these cells. There are no studies looking at clinical outcome measures for cardiovascular disease but a number of studies looking at biochemical markers including arterial wall stiffness and apolipo protein B. Recent studies have also looked at the effects of red clover isoflavone on mood and depression, using specific depression rating scales. Finally, it is important to note that herbal medicinal products should not be used without caution. Some may produce quite marked side-effects in high doses and others can interact with pre-existing medication. A strategy for which patients are suitable for herbal medicinal products is reviewed.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

Phenomenology in End-of-Life Care: Implications for Philosophy and Clinical Practice

Care of the terminally ill and dying in the hospice setting is a growing practice field for social workers. Support to family, as well as the patient, is implicit in hospice care, adding to the reach and impact of the hospice social worker’s role. As people age and approach the end of life, they may encounter changes in their experience of time, space and of the material world. They often have to redefine the role of hope in their day to day lives. Based on these changing experiences and perceptions, phenomenology, with its focus on a patient’s subjective, lived experience, has implications for end-of-life care. The role of empathy and compassion are also explored in relation to existential experiences of the terminally ill through the lens of phenomenology and Eastern philosophy. To complement the Western biomedical model of care for the dying, insight from Eastern philosophical traditions, which view living and dying on the same continuum, and provide an expanded view of suffering bring comfort and understanding to how living and dying are processed within the phenomenology of patient experience and the hospice model of care. Case vignettes demonstrate social work theory and practice at the intersection of various interrelated phenomena when caring for those facing the end of life.     

Beards and Bloomers: Flight Attendants,Grievances and Embodied Labour in the Canadian Airline Industry, 1960s–1980s

This paper examines union grievances dealing with the body, appearance and demeanour fought by the Canadian Air Line Flight Attendants Association, on behalf of its female and male members over a 30‐year period. Taking a historical, materialist‐feminist approach, we examine how workers used the grievance system to resist regulations they believed contradicted their right to dignified labour. We ask how and why bodily regulation differed for men and women, and how this changed over time, as the union merged its male and female job occupations. Using arbitrated grievances, union records and discussion of these issues in the mass media, we show how both feminism and service union activism encouraged flight attendant resistance to airlines’ efforts to regulate the appropriate body and attire for male and female workers. The use of labour law offered workers some respite from regulation, but did not facilitate fundamental questions about the power of management to ‘dress’ its workers.     

The Effect of Infancy Childcare Center Use and Maternal Employment on Toddlers’ Language Development in South Korea

Using first to fourth wave data of the Panel Study of Korean Children (PSKC), this study explores the effects of childcare center use, maternal employment, and other child and familial characteristics on the language development of toddlers in Korea. Among the 2078 families with children in the PSKC, those who completed the Receptive and Expressive Vocabulary Test at the fourth wave were selected, and a small number of disabled or prematurely born children were excluded. In addition, to clarify the effects of maternal employment, families with mothers who were either employed or unemployed for three consecutive years during the child's infancy were selected. Regression analysis showed that neither childcare center use nor maternal employment during infancy had significant effects on toddlers’ expressive and receptive vocabulary at the fourth wave. Family characteristics, such as household poverty and maternal education level, as well as child characteristics, such as gender and birth order, had significant effects on expressed vocabulary. However, only children's gender significantly affected the receptive vocabulary level of toddlers.     

Multiple event times in the presence of informative censoring: modeling and analysis by copulas

Motivated by a breast cancer research program, this paper is concerned with the joint survivor function of multiple event times when their observations are subject to informative censoring caused by a terminating event. We formulate the correlation of the multiple event times together with the time to the terminating event by an Archimedean copula to account for the informative censoring. Adapting the widely used two-stage procedure under a copula model, we propose an easy-to-implement pseudo-likelihood based procedure for estimating the model parameters. The approach yields a new estimator for the marginal distribution of a single event time with semicompeting-risks data. We conduct both asymptotics and simulation studies to examine the proposed approach in consistency, efficiency, and robustness. Data from the breast cancer program are employed to illustrate this research.

     

Polarization: Concepts,Measurement, Estimation

We develop the measurement theory of polarization for the case in which income distributions can be described using density functions. The main theorem uniquely characterizes a class of polarization measures that fits into what we call the “identity‐alienation” framework, and simultanously satisfies a set of axioms. Second, we provide sample estimators of population polarization indices that can be used to compare polarization across time or entities. Distribution‐free statistical inference results are also used in order to ensure that the orderings of polarization across entities are not simply due to sampling noise. An illustration of the use of these tools using data from 21 countries shows that polarization and inequality orderings can often differ in practice.     

Lack of reciprocity among Dutch teachers: Validation of reciprocity indices and their relation to stress and well-being

This research presents the results of two related studies on the convergent and construct validity of three measures of reciprocity in exchange relationships at work. In Study 1, 71 Dutch teachers were interviewed about their specific investments and outcomes in the exchange relationships with their students, colleagues and school. ANOVA revealed that they reported significantly more investments than outcomes, and that the number of reported investments and outcomes mentioned varied as a function of the type of exchange relationship. Building on these results, multi-item scales were created to assess reciprocity at a detailed level for each of the three exchange relationships. Study 2 validated these specific reciprocity measures by relating them to two global assessments of reciprocity (convergent validity) as well as to measures of job stress and well-being (construct validity). LISREL-analysis of data obtained from a further sample of 224 teachers revealed that for each type of exchange relationship there were significant, consistent and meaningful relationships among the three reciprocity measures. Further, hierarchical regression analysis showed that the reciprocity measures were differentially related to job stressors and measures of well-being. Implications are discussed.     

The labor supply of Latinas in the USA: Comparing labor force participation, wages, and hours worked with Anglo and Black women

This study explores the determinants of labor supply patterns among Latinas in the USA. We use recent microeconomic data from the Panel Study on Income Dynamics/Latino National Political Survey (PSID-LNPS) to estimate models of labor force participation, wages, and hours worked for a sample of Cuban, Mexican, and Puerto Rican women. We estimate the same models for Anglo and Black women in order to explore ethnic differences in the impact of characteristics affecting both the reservation and the market wage. We find that differences exist in the return to characteristics, such as education, but that there are also substantial differences in the levels of those characteristics across ethnic groups. The low wage rates and labor market activity of Latinas relative to Anglo and Black women are thus likely to be the combined result of lower investments in human capital and larger family size, the greater negative impact of macroeconomic conditions, and a stronger responsiveness to wages. Among Latinas, we find that there are differences in labor market outcomes between national origin and nativity groups. We also find that age at arrival and years in the USA play a role in labor supply, and that this is particularly true for Puerto Rican women.