Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

Severely Traumatized Siblings: A Treatment Strategy

Siblings who have suffered severe trauma and disrupted attachment relate to one another in ways that interfere with individual development, the chance to benefit from connections with adults, the establishment of healthy sibling relationships, and the working through of traumatic experiences. The authors use case examples to illustrate four distinct sibling patterns: absent, adult lockout, half and half, and trauma shield. The authors highlight the importance of recognizing these types and then varying the therapist's treatment stance to pursue five goals. These include suspending problematic sibling relationships to create room for bonding with caring adults, transferring attachment behaviors and impulses to a receptive adult, resuming healthy individual development, forming more adaptive sibling connections, and expressing shared traumatic content.     

Lessons from the trenches in physician integration

Beyond the theoretical basis for integration, three core considerations stand out as the primary reasons for pursuing integration from a physician's perspective. In the authors' experience, the ability to make a case for physician integration stands or falls based on the ability of the integrated delivery system to address these considerations: Gain greater access to capital; develop human resources with talents in managed care and the full spectrum of care services; and sustain an information infrastructure. This article explores the lessons learned in pursuing physician integration.     

Refugees of Turkish origin: "coerced immigrants" to Turkey since 1945

"While several studies (in both Turkish and English) have been made on migration to the Ottoman Empire from the Caucasus and the Balkans during the nineteenth century...very little systematic and comprehensive research on migration has been undertaken on the period since the establishment of the Turkish Republic. This article, which aims to partially fill the gap, is divided into three parts: the issue of national refugees (refugees of Turkish origin) in relation to Turkey's overall refugee policy; Turkey's policy towards national refugees; and the volume and causes of refugee migration to Turkey since 1945." (SUMMARY IN FRE AND SPA)     

Changes in health, mortality, and disability and their impact on long-term care needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. Among those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes--such as the increasing educational level of the elderly population--is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.     

China's "tidal wave" of migrant labor: what can we learn from Mexican undocumented migration to the United States?

"The purpose of this article is to place Chinese labor migration from agriculture within the context of the literature on labor mobility in developing countries by comparing it to undocumented Mexican migration to the United States. The similarities fall within three general areas: the migration process, the economic and social position of migrants at their destination, and the agrarian structure and process of agricultural development that has perpetuated circular migration. The last section of the article draws upon these similarities, as well as differences between the two countries, to generate predictions concerning the development of labor migration in China."     

Prevalence of gambling among Minnesota public school students in 1992 and 1995

The purposes of this study were to examine the prevalence of gambling among youth, compare rates of gambling between 1992 and 1995, and determine what levels of gambling frequency may be considered common and uncommon. The two samples included 122,700 Minnesota public school students in the 6th, 9th, and 12th grades in 1992; and 75,900 9th and 12th grade students in 1995. Students were administered the Minnesota Student Survey, a 126-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple content domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in both 1992 and 1995 to students in their classrooms by the Minnesota Department of Education. There were slight decreases in overall gambling rates from 1992 to 1995. The majority of students gambled at least once during the past year. However, most did not play any game on a weekly/daily rate and did not report any problems associated with their gambling. Gender, grade, and race effects were found for gambling frequency. Boys gambled more often than girls, and 9th and 12th grade students gambled more often than 6th grade students. Asian American and White students reported lower rates of gambling frequency than Mexican/Latin American, African American, and American Indian students. From a statistical standpoint (i.e., beyond the 97.7 percentile), it may be considered in the uncommon range for girls to play two or more games at a weekly/daily rate, and for boys to play four or more games at a weekly/daily rate. Variables associated with gambling frequency included antisocial behavior, gender, and alcohol use frequency. Although the finding that gambling did not increase from 1992 to 1995 is encouraging, this is the first generation of youth to be exposed to widespread accessability to gambling venues and gambling advertising and it will be important to continue monitoring the prevalence of youth gambling.