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.     

Community standards,conservatism, and judgments of pornography

In an attempt to determine if a community standard existed and to relate judgments of pornography to conservatism, scores on Wilson and Patterson's Conservatism Scale, yes‐no judgments on whether 25 pictures were or were not pornographic, and demographic data were obtained from a random sample (N = 114) of a community. Results were as follows: (1) suggestive evidence for the existence of a community standard; (2) the c‐scale correlated .57 (N = 114, p < .01) with number of pictures judged pornographic; (3) the 25 pictures met Guttman requirements of unidimensionality (reproducibility of .925); and (4) factor analysis of the pornography judgments yielded three clear‐cut factors and one ambiguous factor which were ordered along the Guttman dimension.     

Estimation with right‐censored observations under a semi‐Markov model

The semi‐Markov process often provides a better framework than the classical Markov process for the analysis of events with multiple states. The purpose of this paper is twofold. First, we show that in the presence of right censoring, when the right end‐point of the support of the censoring time is strictly less than the right end‐point of the support of the semi‐Markov kernel, the transition probability of the semi‐Markov process is nonidentifiable, and the estimators proposed in the literature are inconsistent in general. We derive the set of all attainable values for the transition probability based on the censored data, and we propose a nonparametric inference procedure for the transition probability using this set. Second, the conventional approach to constructing confidence bands is not applicable for the semi‐Markov kernel and the sojourn time distribution. We propose new perturbation resampling methods to construct these confidence bands. Different weights and transformations are explored in the construction. We use simulation to examine our proposals and illustrate them with hospitalization data from a recent cancer survivor study. The Canadian Journal of Statistics 41: 237–256; 2013 © 2013 Statistical Society of Canada     

Assessing student learning in the context of evaluating a chance course

This paper describes the use of different assessment methods to evaluate Chance courses in the NSF-funded Chance project. Multiple methods were used to measure changes in students' attitudes and beliefs about statistics, reasoning about probability and statistics, and ability to critique a newspaper article that reports statistical results. Samples of assessment materials and scoring rubrics used in the evaluation are included.     

The therapeutic value of women's adult friendships

Abstract

In 1980, thirty‐five years after the end of World War II, the long‐term impact of war‐trauma on individuals’ lives led to concern about Post‐Traumatic Stress Disorder. While the focus here is not on “disorders,” it is on interactive patterns of “defensive” caretaking behaviors which contribute to intergenerational transmission of anxiety, silence and losses related to the Holocaust. In this long‐term group, defensive caretaking patterns are conceptualized as second‐generation behaviors which focus on parental needs thereby avoiding addressing second‐generation vulnerabilities. Relevant concepts of Sullivan, Winnicott, Bion and Fairbairn are applied. In an innovative trauma group design, defensive caretaking patterns are illustrated through clinical examples and interventions by the therapist as a “validating object” work to mitigate transmission to still the next generation.