Treating cardiovascular disease in women

Cardiovascular disease (CVD) is the most common cause of death in women but some of the challenges of management differ from those in men. This article addresses the gender-specific issues of cardiovascular management, with emphasis on ischaemic heart disease and modification of coronary risk factors. Women with ischaemic heart disease present later than men, and are therefore older and more likely to suffer from co-morbidities such as diabetes and hypertension. Proven CVD risk factors in women can be divided into those that are modifiable and those that are non-modifiable. The former include diabetes, dyslipidaemia, hypertension, smoking, obesity, sedentary lifestyle and poor nutrition; the latter include family history of heart disease and older age at presentation. It is this difference in age and general health that explains much of the variability in response to treatment. Pharmacotherapy, percutaneous intervention, surgical revascularization, and cardiac rehabilitation and disease prevention are discussed.     

Do male and female gamblers have the same burden of adversity over their life course?

The objective of this research is to investigate gender difference and the burden of adversity during the life course of people who develop gambling problems. A sample of 86 adult participants met the criteria for at-risk problem gambling over the last 5 years. Data were obtained from informants during semi-structured face-to-face interviews, using SCID I and II, SOGS, Module K and a recount of life trajectories methodology. The results showed a high level of adversity throughout the life trajectories of the men and women studied. The results indicated that the major load of mental health disorders, the presence of anxiety disorders and co-morbid mental health disorders are more significant among women. Results also indicated a significant presence of violence in the lives of both men and women during early childhood and adolescence. During adulthood, women are more likely to be victims of intimate partner or marital violence whereas men tended to cumulate difficulties in social fields and especially in their professional lives. This significant burden of adversity creates a number of difficulties which makes it complicated to isolate gambling activities. Clinicians might have difficulty detecting female gamblers during consultation, especially when they present with co-morbid mental health disorders and violence issues.     

Introduction

The present study investigates whether hypothesized cognitive mechanisms of change mediate the efficacy of cognitive-behavioral therapy (CBT) delivered online for treating depression and anxiety disorders. Articles were included by searching MEDLINE, PsychInfo and PsychArticles databases from January 1980 to March 2011. The inclusion criteria were as follows: (a) randomized clinical trials investigating the role of CBT delivered online, (b) patient sample had clinical or subclinical intensity emotional problems, (c) at least one measure of cognitions was included, (d) the inclusion of a control group, and (e) sufficient data provided to allow calculation of effect sizes. Eleven articles were selected. Results revealed a moderate overall effect size of CBT (d = .67, P < .05) on the combined cognitive and emotional outcomes. A positive impact of online CBT on cognitive factors (d = .69, P < .05) and emotional outcomes (d = .63, P < .05) was independently demonstrated. In conclusion, cognitive-behavioral therapy delivered online can be used as an efficacious treatment for patients with emotional disorders. Assuming causal effects, the data indicate that cognitive factors are an important mechanism of change in online CBT. Future online CBT focusing on changing cognitions are likely to be efficacious.     

Homelessness and Substance Abuse: Which Comes First?

Abstract

The present paper uses a social selection and social adaptation framework to investigate whether problematic substance use normally precedes or follows homelessness. Clarifying temporal order is important for policy and program design. The paper uses information from a large dataset (n=4,291) gathered at two services in Melbourne, supplemented by 65 indepth interviews. We found that 43% of the sample had substance abuse problems. Of these people, one-third had substance abuse problems before they became homeless and two-thirds developed these problems after they became homeless. We also found that young people were more at risk of developing substance abuse problems after becoming homeless than older people and that most people with substance abuse issues remain homeless for 12 months or longer. The paper concludes with three policy recommendations.     

Is Elder Abuse and Neglect a Social Phenomenon? Data from the First National Prevalence Survey in Israel

This article discusses findings from the First National Survey on Elder Abuse and Neglect in Israel, conducted during 2004–2005 under the sponsorship of The Association for Planning and Development of Services for the Aged in Israel (ESHEL) and the National Insurance Institute. The goals were to examine the prevalence and severity of various forms of abuse and neglect from the victims' perspective, to examine correlates and predictors, and to develop profiles of elders at risk. Data were collected through personal interviews from a national representative sample of community urban dwellers age 65 and older, using cluster sampling techniques and sampling proportionately both Arab and Jewish elders. The sample was composed of 392 males and 650 females, 89% were Jews and 11% were non-Jews. The instrument included sociodemographic data, health and activities of daily living (ADL), a measure of safety, and a battery to examine seven types of abuse (physical, emotional, verbal, limitation of freedom, financial exploitation, sexual, and neglect). Findings indicate that 18.4% of the respondents were exposed to at least one type of abuse during the 12 months preceding the interview, the highest form being verbal abuse followed by financial exploitation. The rates were quite similar between Jews and Arabs. Women were more exposed to physical violence and Arab women were the most vulnerable. Physical, emotional, verbal, limitation of freedom, and sexual abuse occurred mostly among partners. The rates of physical, sexual, and limitation of freedom abuse, however, were relatively low. Financial exploitation was mostly inflicted by adult children. Partners as perpetrators had more chronic health problems and physical and mental disabilities. Children as perpetrators were unemployed, had various mental health problems, and were substance abusers, often in a process of separation or divorce and tended to live with the victims. Neglect in answering primary needs was found among 20% of the sample, regarding the 3 months preceding the interview. This high rate might be related to elders tending to avoid seeking help or sharing their needs with their families. When victims sought help it was mostly from medical and health services. The findings thus corroborate that elder abuse and neglect is a social problem in Israeli society and has to be addressed in policy discourse and service developments.     

Evaluating the impact of conditional cash transfer programs on fertility: the case of the Red de Protección Social in Nicaragua

Evaluating the impact of poverty-reduction programs on fertility is complicated given that changes in incentives to have children take time to be incorporated into decision making and evaluation periods are usually quite brief. We explore the use of birth spacing as a short-run indicator of the impact of poverty-reduction programs on fertility. The data come from a Nicaraguan conditional cash transfer program that offers incentives for poor households to invest in children??s health, nutrition, and education. We estimate a stratified Cox proportional hazard model and find that the program decreased the hazard of a birth, indicating an increase in birth spacing.     

A resilience enhancing trauma-informed program for children and mothers in domestic violence shelters: A qualitative study

In domestic violence (DV) shelters, offering psychosocial support services to mothers and children is vital. The program ‘Time for Tony the Turtle’ has been developed for mothers and children residing in DV shelters in the Netherlands. It aims to foster attachment and regulation skills, which can also prepare for trauma treatment if sought after later on. This qualitative study explores the experiences of mothers, children and professionals with the program and its perceived impact and what components function as facilitators and barriers in the implementation of such a program in DV crisis shelters in the Netherlands. We conducted in-depth interviews with 15 mothers, 11 children and 18 professionals from three organizations offering DV shelters. We used thematic analysis to identify patterns of meaning in the interviews. Mothers, children and professionals valued that the program provided a calm moment for reflection in hectic times and that the playfulness in which the program addressed trauma-related topics. However, mothers find it difficult to attend the program in the beginning of their shelter stay, therefore hampering the applicability of the program. Our findings suggest that integrating the topic of discussing father in a program in crisis shelters is complex and deserves more attention.     

The Impact of Cultural Orientation and Higher Education on Young Israeli Jewish and Arab Adults’ Notion of the Adaptive Adult

This quantitative study compares young adults’ notions of the adaptive adult prior to becoming parents in Israel together with the moderating effect of academic education and culture on these notions. Participants were drawn from Israel's two largest ethnic groups: Jews and Muslims. The research findings indicate that each group's ideal image of the adaptive adult is constructed prior to parenthood. The findings may also indicate acculturation process among Muslim Arabs in Israel who are exposed to individualistic values (Israeli Jewish society). This process may modify personal values and preference regarding the ideal adaptive adult in order to integrate themselves and their future offspring into that society. This trend was found to be more common among highly educated members of the collectivist society.     

Thoughts and acts of self-harm,and suicidal ideation,in online gamblers

Gambling problems have been linked to suicidal ideation and enhanced risk of suicide attempts. However, we know very little about the factors associated with either thoughts or acts of self-harm amongst people who gamble. A web-based study of 4125 online gamblers (79% males; mean age 35.5 years), analysed using hierarchical multiple regression, revealed that self-reported non-gambling-related self-harm was negatively related to age and marital status, and positively related to problematic alcohol use. Self-reported acts of self-harm both related and unrelated to gambling were associated with drug misuse. Thoughts and acts of gambling-related self-harm were associated with problem gambling, gambling involvement and parental problem gambling. All types of self-harm were associated with mood disorder symptoms, unemployment and certain gambling motivations. When tailoring assessment and interventions for individuals at risk for gambling-related deliberate self-harm, it is important to recognize that contributory factors may include some that differ from those for deliberate self-harm in general, and that there is potential value in evaluating gambling involvement and motivations, and history of parental gambling.