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.     

The development of social pedagogy in Spain: The tension between social needs,political response and academic interests

The Spanish Civil War (1936—1939) interrupted the evolution and development of social pedagogy, which in Spain had reached similar levels as in other European countries. This was followed by a period when Spain was isolated from developments in social welfare and the changes that go along with the economic and social transformations of cities and give rise to community action, self-help and popular education programmes. The reinstatement of democracy and of new City Councils that are genuinely devoted to solve the problems of the population are the starting point for new social services, that is for social work and social pedagogy. Initially it was practical work that gave an answer to emerging demand, followed by theoretical analysis and efforts of conceptualisation. The professionals and later the universities lead the debate on methodology. The interest and involvement of the universities increased as the Diploma in Social Education was introduced as a new university degree.     

Institutional Ethnography and Experience as Data

Experience, as concept, is contested among feminists as to its epistemological status, thus its usefulness in knowledge claims. Institutional ethnography (Smith 1987) is a feminist methodology that nonetheless relies fundamentally on people's experience. Not as Truth, nor the object of inquiry, but as thepoint d'appui for sociological inquiry. This article offers a demonstration of institutional enthnography using observational and interview data that show experience as methodologically central to a trustworthy analysis. A moment in the work lives of nursing assistants in a long-term care setting is captured by a participant observer. The analysis produces two lines of argument. One is methodological; it is argued that nursing assistants' experiences are an entry into the social relations of the setting that, when mapped and disclosed, make those experiences understandable in terms of the ruling arrangements permeating both the organization and their own experiences. The other argument is substantive; the inquiry uncovers how a quality improvement' strategy in a long term care hospital in Canada is reorganizing caregivers' values and practices toward a market orientation in which care appears to be compromised. Use of experience as data in this approach holds the analysis accountable to everyday/everynight actualities in a lived world.     

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.     

Mandatory seat belt laws in the states. A study of fatal and severe occupant injuries

This study examines the impact of mandatory seat belt laws on fatal and incapacitating injury rates in the states. Annual data for all 50 states for the period 1975-1991 are used. Pooled time series analysis is employed. The general conclusion that emerges from this analysis is that seat belt laws significantly impact state fatal injury rates. Primary enforcement and all-seat coverage provisions appear to be particularly effective in reducing fatality rates.     

Validating quality indicators. Quality as relationship between structure, process, and outcome

Theory and research have not kept pace with the growing interest in evaluating quality of mental health care, resulting in the use of unvalidated quality indicators. A framework for validating quality indicators is offered by which quality is viewed as the relationship between service structures, processes, and outcomes. Adoption of this framework will facilitate the measurement of quality using valid indicators and should be useful to agencies in their continuous quality improvement efforts. Valid information about the quality of mental health care services will help purchasers and consumers make more informed health care decisions.