Medication Abortion Within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

Abstract

Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants: Female patients presenting for medication abortion at a student health care clinic between October 1, 2006, and April 1, 2009. Methods: Retrospective consecutive case review. Results: Successful completion not requiring uterine aspiration occurred in 85% of the cases that were not lost to follow-up. Six cases (15%) required uterine aspiration for completion: 3 underwent uterine aspiration only; 3 had aspiration after failing an additional dose of misoprostol. Only 1 patient visited the emergency room. There were no hospitalizations. Conclusions: Medication abortion services in a student health care clinic are safe and feasible. However, additional treatment may be required with some patients.     

An analysis of the relationship between parenting self-efficacy,the quality of parenting,and parental and child emotional health

ABSTRACT

The relationship between parenting self-efficacy, the quality of parenting, and parental and child emotional health has been conducted with Caucasian families and young children. The purpose of this study was to examine these relationships in ethnically diverse and impoverished families with children who have behavior problems. We examined the relationships between parenting self-efficacy, parenting practices, child externalizing problems, and caregiver depression. Participants included 213 caregivers of children with Oppositional Defiant Disorder (ODD), who rated their parenting self-efficacy and completed questionnaires on parenting practices (APQ and FAD); child externalizing behaviors (Iowa Connors Inattention and ODD subscales); and caregiver depression (CESD). Data were examined using Chi-Square tests, a Linear Regression, and a One-Way ANOVA. Results demonstrate parenting self-efficacy was positively associated with positive parenting and inversely associated with inconsistent discipline. Among parents who perceived themselves as being a “better than average parent,” there was a greater percentage of youth who met cutoff for inattention problems as compared to youth who did not meet this cutoff. Lastly, depression scores were lowest for caregivers identifying as below average parents. This study underscores the need for involving parents and enhancing parenting self-efficacy in interventions targeting Disruptive Behavior Disorders.     

Oppression and Barriers to Service for Black,Lesbian Survivors of Intimate Partner Violence

This narrative study identified service barriers from the perspectives of 16 Black lesbian survivors of intimate partner violence (IPV). Qualitative analysis revealed diverse interrelated barriers similar to those identified by service providers in a previous study by the authors, including societal barriers such as heterosexism, and institutional barriers such as ambiguous policy. Results indicate that the theory of intersectionality is best poised to frame an investigation of the complex barriers encountered by these survivors. Results also demonstrate that although these women desire to receive services, current inequities prevent them from accessing support and further endanger, victimize, and isolate them. Strategies for improving services and reaching culturally diverse survivors are also discussed.     

Sustainability Processes among Naturally Occurring Retirement Community Supportive Service Programs

ABSTRACT

Sustainability remains a concern for community models to better support older adults’ aging in place in their own homes and communities. Based on qualitative data from leaders of 53 Naturally Occurring Retirement Community (NORC) Supportive Service Programs, which is among the most prominent community practice models in aging, we aimed to develop an empirically-grounded framework on sustainability processes. Results indicated that programs use funding, staff members, interorganizational partnerships, and volunteers to offer services to attract older adults, and that older adults’ participation, in turn, is perceived as influencing the accrual of additional resources. Across themes, respondents discussed the importance of being responsive to the community and facilitating consumer participation.     

A Qualitative Study of Non-Affiliated,Non-Scientist Institutional Review Board Members

In addition to outlining criteria for the approval of human subjects research, federal regulations provide guidance regarding local institutional review board (IRB) membership. IRBs are mandated to include “at least one member whose primary concerns are in nonscientific areas” and “at least one member who is not otherwise affiliated with the institution.” Often a single individual serves both of these roles simultaneously. Although there have been calls for increased representation of lay community members on IRBs, little is known regarding their experiences or their perceptions of human subject protections and the IRB process. Using an ethnographic interview approach, this study seeks to gain a perspective from non-affiliated, non-scientist (NA/NS) IRB members about the process in which they participate. Findings suggest a need for clarification regarding whom NA/NS IRB members represent. They also suggest that NA/NS IRB members’ experiences could be improved by an increased show of respect from the IRB chair, other members, and staff; efforts to make participation more convenient for these volunteer members; and training tailored specifically to NA/NS members. Further research on this important and understudied topic is needed to determine best practice and policy recommendations.     

Grandchildren Caring for Grandparents: Modeling the Complexity of Family Caregiving

ABSTRACT

This study focuses on grandchildren (Generation 3 or G3) caring for grandparents (Generation 1 or G1) and uses agent-based modeling to conceptualize and test a model of two factors—capability and motivation—that may affect a G3's decision to provide care for a G1. We tested our conceptual model and found that the simulated proportion of G3 caregivers has concurrent validity with existing empirical data. In experiments conducted with the validated model, we investigated universal- and targeted-policy changes (tax credit for caregivers) and found that although the universal-policy change increased G3 caregiving overall, a policy change targeting low- and middle-income caregivers was even more successful.     

Depression in Older Adults: A Meta-Synthesis

Depression in older adults is often overlooked and dismissed as a part of aging. A body of knowledge—both quantitative and qualitative—has developed on the topic of depression in older adults. Meta-analyses and systematic reviews have been used to synthesize the quantitative findings of studies, and our research seeks to synthesize the qualitative studies that have been conducted on elders' experience with depression. Thirteen studies met inclusion criteria, and 4 major themes were extracted: experiences, causes, recovery, and barriers to treatment. These themes are detailed and their implications for practice are explored.     

Optimizing Geriatric Social Work Education: Program and Individual Characteristics That Promote Competencies

Since 1998, the Hartford Partnership Program in Aging Education (HPPAE) has been implemented in over 70 graduate social work programs. This study examined whether program and individual student characteristics are associated with students' knowledge, skills, and values in aging. We conducted a secondary analysis of national program evaluation data. Results from hierarchical linear models indicated greater gains in knowledge of aging among full-time students, as well as students in programs that had defined field rotation models and/or that made greater use of geriatric social work competencies. Implications for efforts to enhance graduate social work education in aging are discussed.     

Welfare states and social mobility: How educational and social policy may affect cross-national differences in the association between occupational origins and destinations

Cross-national differences in the association between origins and destinations correspond to differences in both welfare regime type and access to post-secondary education. Socialist and social democratic welfare regimes foster a weaker origin–destination association than liberal, corporatist, or mixed regimes do. Nations with better-educated labor forces tend to also be the nations where the association between origins and destinations is weakest. Furthermore, the social and educational policy interact so that the tendency for educational access to lower the origin–destination association is most pronounced in the liberal welfare setting where the association would otherwise be greatest. Greater access is not necessarily associated with greater equality of opportunity, and we find very weak evidence that equality of educational opportunity itself is a direct influence on equality of occupational opportunity (even though nations that have a strong origin–education association also have a strong origin–destination association).     

The making of a ghetto: Spatially concentrated poverty in New York City in the 1980s

In recent years a debate has arisen over which of two mechanisms — class selective household mobility or spatially focused increases in poverty — has been the driving force in concentrating poverty in certain inner-city neighborhoods. This paper utilizes a multivariate analysis to identify the processes underlying areal income-class transition in New York City during 1978–1987, and the areal characteristics that predict a consistent path of change. By anchoring the analysis at the level of the individual housing unit, this study disentangles the competing mechanisms of poverty concentration and demonstrates that both selective mobility and shifts in income class contribute to areal income-class transition, but that the latter mechanism accounts for a greater amount of change. Further, after controlling for the proportion of minority residents and public housing units in the area, the results show that location in poor areas is associated with poor in-movement, nonpoor out-movement, and downward shifts in the income class among long-term residents. These mutually reinforcing processes lead to continued decline in extreme- and high-poverty areas, while processes in the opposite direction sustain the economic vitality of low-poverty areas.An earlier version of this paper was presented at the 1992 meetings of the Population Association of America in Denver, Colorado.