The decision making process of older adults who elect to receive ECT

Although there is extensive literature on electroconvulsive therapy (ECT), little documentation exists about how an individual makes the decision to receive ECT. This phenomenological study is an exploratory examination of the decision making process of older adults with mental illness who elect to receive ECT. Study participants included 7 older adults without dementia from a suburban geriatric medicine/psychiatry practice who elected to receive ECT. The lived experience of decision making as perceived by these 7 participants was a process that moved them toward wellness. The data revealed four significant themes: Support, Trust, Past Experience, and Desperation. An overriding substantive theme identified as an obstacle was the Stigma of Mental Illness. This study provided a basis for planning clinical practice and building further research.     

Knowing Terrible Things: Engaging Survivors of Extreme Violence in Treatment

Survivors of extreme violence can be difficult to engage in treatment. Often this is caused by a sense of isolation drawn from the belief that no one who has not shared their experience can comprehend it. The only others who know what they know are those who have died of the violence, fellow survivors and the perpetrators. The clinician attempting to treat such patients may be placed in a dilemma: how to convey the capacity to know terrible things without being destroyed by the survivor, while at the same time not conveying that one is dangerous oneself. This paper suggests a method of utilizing unconscious aggressive fantasy to access the capacity to convey to the survivor that it is possible to hear, understand and contain violent experience. Case illustrations indicate how such capacity might be conveyed, so that a treatment alliance can begin.

Osteoporosis knowledge and attitudes: a cross-sectional study among college-age students

OBJECTIVE: The authors' purpose in this study was to investigate the influence of knowledge of osteoporosis, attitudes regarding osteoporosis, and knowledge of dietary calcium on dairy product intake in both male and female college-age students. PARTICIPANTS: The authors conducted this cross-sectional study on 911 men and women enrolled in 2 demographically similar universities. METHODS: A modified osteoporosis knowledge questionnaire assessed participant's general osteoporosis knowledge and perceived disease risk. RESULTS: The authors found that knowledge of osteoporosis and calcium did not significantly influence dairy product intake. Attitude regarding osteoporosis was a significant predictor of dairy product intake in men but was not significant for the women. CONCLUSIONS: The authors recommend development and implementation of educational programs designed to increase awareness of calcium-rich food sources as well as other risk factors of this crippling disease.     

Bleeding with menopausal hormone therapy: physiological or pathological?

Abnormal bleeding is a common reason for discontinuation of hormone replacement therapy. There is little consensus regarding when to investigate abnormal bleeding, what to do about persistent bleeding or when reinvestigation is indicated. Transvaginal ultrasound, endometrial biopsy and hysteroscopy are discussed. The mechanisms of this bleeding are poorly understood and do not correlate well with endometrial histology or the type or dose of hormone therapy used. Endometrial bleeding requires breakdown of endometrial vessels and their overlying epithelium. Endometrial vascular breakdown appears to be largely locally regulated. Potential mechanisms involved in endometrial bleeding include: changes in the ratio of vascular endothelial growth factor (pro-angiogenic) to thrombospondin-1 (anti-angiogenic); alterations in matrix metalloproteinases and their tissue inhibitors; changes in endometrial haemostasis due to tissue factor; and increased endometrial leucocytes.     

Social Work Practice in Higher Education

This article examines two cases of social work practice in higher education within the context of identifying a model of social practice for use in postsecondary educational settings. The case studies provide insight into a model of social work practice that reflects both the traditional clinical model, which focuses on individual change, and the school-community-pupil relations model, which focuses on system change. The author also discusses implications for social work educators who see college/university counseling centers as an arena for social work practice.     

Step Up Love Story: Futari Etchi. By Katsu Aki

REPRODUCTIVE ETHICS. Michael D. Bayles. Englewood Cliffs, NJ: Prentice‐Hall, 1984; 141 pages; $10.95.

EXPLORING GENDER RELATIONS: A CANADIAN PERSPECTIVE. Marlene Mackie. Toronto: Butterworths, 1983; 358 pages; $17.95 (pa.).

SARAH: A SEXUAL BIOGRAPHY. Paul R. Abramson. Albany, NY: State University of New York Press, 1984; 142 pages; $9.95 (pa.); $29.50 (cl.).

SENSUOUS SPACES: DESIGNING YOUR EROTIC INTERIORS. Sivon Reznikoff. New York: Whitney Library of Design, Watson‐Guptill Publications, 1983; 204 pages; $32.50.

SEXUALLY TRANSMITTED DISEASES: AN ANNOTATED, SELECTIVE BIBLIOGRAPHY. Stephen Margolis. New York: Garland, 1985; 176 pages; $23.00.

WOMEN AND DEVIANCE: ISSUES IN SOCIAL CONFLICT AND CHANGE; AN ANNOTATED BIBLIOGRAPHY. Nanette J. Davis and Jone M. Keith. New York: Garland, 1984; 236 pages; $35.00     

Disability stigmatization as a barrier to employment equity for legally-blind Canadians

Canada has expressed a strong commitment to the rights of its citizens against discrimination, including those with disabilities. A question remains whether Canadians with disabilities are able to practice these rights. Our mixed-methods study sheds light on the situation of one important sub-group of people with disabilities – those who are legally blind. Our survey results show that the labour-force participation rate for this population is very low compared with those without disabilities, and also lower than the rate for persons with other disabilities. Legally-blind working-age Canadians have significantly higher rates of unemployment and underemployment, and perceive major barriers to employment. In-person interviews reveal the negative impact of one major barrier – disability stigmatization – on accessing meaningful employment and other societal assets. We discuss the implications of these findings and suggest policy directions.     

Factors Associated with Suicidal Ideation Among Women Abused in Intimate Partner Relationships

This study examines factors associated with suicidal ideation among women abused in intimate partner relationships. Data were collected from the case records of 95 women screened upon in‐person contact with admissions workers in a domestic violence shelter in one Midwestern state. Forty‐three percent of the women reported suicidal ideation as significantly associated with childhood sexual abuse, childhood physical abuse, and adulthood intimate partner abuse lasting fewer than 12 months in duration. The results have policy and practice implications for those interested in the mental health needs of women abused in childhood and adulthood. Implications for research are presented that more precisely identify how the effects of past and current traumatic experiences intersect and contribute to suicidal ideation among women abused in intimate relationships.