Overcoming medication refusal using a patient-centered approach

The refusal of psychotropic medication is a challenge faced by many healthcare providers when treating patients with mental illness. Controversy surrounds medication refusal because some mental health professionals believe that psychiatric patients should be forced to take medications for the safety of the general public, while patients are often acutely aware of potential lifelong adverse side effects and are sometimes reluctant to comply. The proposed alternative to this problem begins with developing the patient-provider relationship through a patient-centered approach. This approach emphasizes the individual needs of patients and creates opportunities for input from patients about their care, which helps form relationships of mutual trust and respect between patients and providers. This article explores the literature to: (1) understand some of the challenges and controversies involved in patient medication refusal from a clinical and societal level; (2) identify some issues in a patient-centered approach; and (3) make some brief clinical and policy recommendations that might help to bring about an increase in the use of patient-centered care. Hopefully, as efforts are made toward a patient-centered approach, increased psychotropic medication adherence and decreased medication coercion will result as providers listen and act upon the needs of their patients.     

Assessing Participation and Effectiveness of the Peer-Led Approach in Youth Sexual Health Education: Systematic Review and Meta-Analysis in More Developed Countries

Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in more developed countries (MDCs). Electronic and manual searches across five social science, education, and medical databases were conducted. Fifteen articles were selected in total. Most (10 of 15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13 of 14) and attitudes (11 of 15) at postintervention stages. Two studies showed improved self-efficacy, and three showed behavioral changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges’ g = 0.84, 95% confidence interval [CI]: 0.43 to 1.25) and a medium effect on attitude change (Hedges’ g = 0.49, 95% CI: 0.19 to 0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitudes but not behaviors. Further research and action are needed to understand optimal implementation.     

A New Paradigm for Understanding Women's Sexuality and Sexual Orientation

Major scientific findings about women's sexuality and sexual orientation are reviewed. Sexual orientation is unrelated to mental health. There is no inherent association between gender conformity and women's sexual orientation; masculinity and femininity are linked to sexual orientation in some social contexts but not in others. Research has so far failed to identify major biological or childhood antecedents of women's sexual orientation. Women's sexuality and sexual orientation are potentially fluid, changeable over time, and variable across social contexts. Regardless of sexual orientation, there are important commonalities in women's sexuality. In particular, women tend to have a relational or partner-centered orientation to sexuality. Together, these findings provide the basis for a paradigm shift in the conceptualization of women's sexual orientation.     

Environmentalism and Public Policy: Environmental Justice: Grassroots Activism and Its Impact on Public Policy Decision Making

A growing body of evidence reveals that people of color and low-income persons have borne greater environmental and health risks than the society at large in their neighborhoods, workplace, and playgrounds. Over the last decade or so, grassroots activists have attempted to change the way government implements environmental, health, and civil rights laws. Grassroots groups have organized, educated, and empowered themselves to improve the way government regulations and environmental policies are administered. A new movement emerged in opposition to environmental racism and environmenttal injustice. Over the last decades or so, grassroots activists have had some success in changing the way the federal government treats communities of color and their inhabitants. Grassroots groups have also organized, educated, and empowered themselves to improve the way health and environmental policies are administered. Environmentalism is now equated with social justice and civil rights.     

Role constraints and first ladies

The First Ladyship is an institution that consists not only of the perceptions of its various occupants, and the accumulated precedents they have established, but also of the perceptions of the various audiences to which the First Ladies have played, and the elite and popular expectations that have accumulated over time in response to those precedents. Certain roles and their attendant behaviors are, thus, more likely than other roles and behaviors to attract elite and/or popular supports, whereas others are more likely to founder against one or more of the audience constraints that are part of the political ecology in which any First Lady operates.     

Upbringing and Socialization in Today's Russia: Risks and Opportunities

Throughout the world there is a growing understanding of information as a most important product of social production, as a constantly growing resource of mankind, as a most valuable and popular commodity in international trade. Information and propaganda based on it have become a powerful means that can be used to solve the most complex problems, including those that have more than once in history led to armed struggle. The tendency toward the increased role of information in the life of society is the basis for the conclusion that under the present conditions of historical competition the socioeconomic system that will win is the one that possesses the higher quality information, that assimilates it faster, in greater volume, and more efficiently for the attainment of mankind's common goals.     

Students' Attitudes Toward Religion

A study of the value structure of students investigates correlations of value hierarchies with religious/secular orientations and exposure to school curricula incorporating a course in Orthodox culture.     

Estimating the effectiveness of a misdemeanor drug diversion program using propensity score matching and survival analyses

This study analyzes three years of data on misdemeanor drug offenders in Winnebago County, Wisconsin. A portion of these offenders opted into a Misdemeanor Drug Diversion Program (MDDP) offered instead of traditional adjudication. Recidivism in the treatment and comparison groups is estimated using standard binary response techniques augmented with propensity score matching to address selection bias. Results show that the MDDP reduces the probability of re-offense by 16%, after adjusting for possible selection bias. Cox proportional hazard modeling is also used to assess time-to-re-offense differentials between the treatment and comparison groups. The survival analysis indicates that the hazard rate of re-offense is 60% lower per day among those treated with the MDDP program than those who did not complete the program. The average number of days to re-offense among those that do re-offend is 297 days in the treatment group and 203 days in the comparison group.