Do housing tenure and car access predict health because they are simply markers of income or self esteem? A Scottish study.
OBJECTIVE: To investigate relations between health (using a range of measures) and housing tenure or car access; and to test the hypothesis that observed relations between these asset based measures and health are simply because they are markers for income or self esteem. DESIGN: Analysis of data from second wave of data collection of West of Scotland Twenty-07 study, collected in 1991 by face to face interviews conducted by nurse interviewers. SETTING: The Central Clydeside Conurbation, in the West of Scotland. SUBJECTS: 785 people (354 men, 431 women) in their late 30s, and 718 people (358 men, 359 women) in their late 50s, participants in a longitudinal study. MEASURES: General Health Questionnaire scores, respiratory function, waist/hip ratio, number of longstanding illnesses, number of symptoms in the last month, and systolic blood pressure; household income adjusted for household size and composition; Rosenberg self esteem score; housing tenure and care access. RESULTS: On bivariate analysis, all the health measures were significantly associated with housing tenure, and all except waist/hip ratio with car access; all except waist/hip ratio were related to income, and all except systolic blood pressure were related to self esteem. In models controlling for age, sex, and their interaction, neither waist/hip ratio nor systolic blood pressure remained significantly associated with tenure or care access. Significant relations with all the remaining health measures persisted after further controlling for income or self esteem. CONCLUSIONS: Housing tenure and car access may not only be related to health because they are markers for income or psychological traits; they may also have some directly health promoting or damaging effects. More research is needed to establish mechanisms by which they may influence health, and to determine the policy implications of their association with health. (+info)
The impact of genetic counselling about breast cancer risk on women's risk perceptions and levels of distress.
Women referred to a familial breast cancer clinic completed questionnaires before and after counselling and at annual follow-up to assess their risk estimate and psychological characteristics. The aims were to determine whether those who attended the clinic overestimated their risk or were highly anxious and whether counselling influenced risk estimates and levels of distress. Women (n = 450) at this clinic were more likely to underestimate (39%) than overestimate (14%) their risk. Mean trait anxiety scores were higher than general population data (t = 4.9, n = 1059, P<0.001) but not significantly different from published data from other screening samples. Overestimators (z = 5.69, P<0.0001) and underestimators (z = -8.01, P<0.0001) reported significantly different risk estimates (i.e. increased accuracy) after counselling, but significant inaccuracies persisted. Over- (n = 12) and underestimators (n = 60) were still inaccurate in their risk estimates by a factor of 2 after counselling. Thirty per cent of the sample scored above the cut-off (5/6) for case identification on a screening measure for psychological distress, the General Health Questionnaire (GHQ). GHQ scores were significantly lower after counselling (t = 3.6, d.f. = 384, P = 0.0004) with no evidence of increasing risk estimate causing increased distress. The risk of distress after counselling was greater for younger women and those who were more distressed at first presentation. The counselling offered was effective in increasing the accuracy of risk perceptions without causing distress to those who initially underestimated their risk. It is worrying that inaccuracies persisted, particularly as the demand for service has since reduced the consultation time offered in this clinic. Further work is needed to evaluate alternative models of service delivery using more sophisticated methods of assessing understanding of risk. (+info)
The broken mirror. A self psychological treatment perspective for relationship violence.
Clinicians face formidable challenges in working with male perpetrators of domestic violence. Many treatment programs use a confrontational approach that emphasizes male entitlement and patriarchal societal attitudes, without honoring the genuine psychological pain of the abusive male. Although some men with strong psychopathic tendencies are almost impossible to treat, the majority of spouse-abusing males respond best to an empathic, client-centered, self psychological approach that also includes education about sociocultural issues and specific skill building. Understanding the deprivations in mirroring selfobject functions from which these men typically suffer facilitates clinical treatment response. While insisting that men take full responsibility for their abusive behavior, treatment approaches can still be most effective by addressing inherent psychological issues. Group leaders who can offer respect for perpetrators' history, their experience of powerlessness, and their emotional injuries in primary relationships are more likely to make an impact. (+info)
Can we create a therapeutic relationship with nursing home residents in the later stages of Alzheimer's disease?
1. Despite their entrance into advanced illness, the majority (83%) of participants in the study displayed evidence of having begun a therapeutic relationship with their assigned advanced practice nurse. 2. With one exception, those participants who did not evidence development of the relationship had severely limited speech, perseverative speech, or did not speak at all. 3. It is time to challenge the assumption that individuals in the middle and later stages of Alzheimer's disease are not good candidates for developing a therapeutic relationship. (+info)
Measuring intermediate outcomes of violence prevention programs targeting African-American male youth: an exploratory assessment of the psychometric properties of six psychosocial measures.
This study examined the psychometric properties of six psychosocial measures that may be useful indicators of intermediate outcomes of violence prevention programs targeting African-American male youth. Baseline and 6 month follow-up survey data are used from 223 African-American male 12-16 year olds participating in a violence prevention program evaluation study. The constructs of interest are beliefs supporting aggression, aggressive conflict-resolution style, hostility, ethnic identity, self-esteem and hopelessness. Each construct is measured as a multi-item scale. Exploratory factor analysis results provided limited support for the unidimensionality of these scales, thus suggesting that further scale development is warranted. Reliability coefficients for the scales ranged from 0.55 to 0.80. Bivariate analyses with baseline data indicate that all six measures have construct and criterion-related validity, as they are associated with each other and with four behavioral criteria in the expected directions. Predictive validity was also demonstrated for beliefs supporting aggression, aggressive conflict-resolution style, hostility and hopelessness which were associated with weapon-carrying behaviors measured in the 6 month follow-up survey both before and after controlling for corresponding behaviors measured in the baseline survey. (+info)
The UMDS MSc in general practice: attainment of intended outcomes.
BACKGROUND: The United Medical and Dental School's (UMDS's) MSc in general practice is one of the longest running courses of its kind. Although descriptive accounts of such courses have been published, little is known about their outcomes. AIM: To measure the extent to which graduates feel they have personally achieved 16 intended outcomes derived from the course objectives, and to record current academic activities, particularly teaching and research. METHOD: A postal questionnaire to graduates of the UMDS MSc in General Practice. RESULTS: The response rate was 93%. Of the 71 responders, 23 have gone on to register for or complete other degrees or diplomas. Over two-thirds of responders had an academic commitment following the MSc. Two-thirds were currently engaged in research and over half reported having had work accepted for publication. The majority of graduates confirmed the attainment of all 16 outcomes, although outcomes related to personal achievements were endorsed more strongly than those related to service delivery. CONCLUSION: UMDS graduates are making a significant contribution to their discipline and are unanimous in describing the course as an important event in their personal development. As a result of this study, the course organizers are seeking to increase the links between academic study and everyday practice. (+info)
Health status: patient and physician judgments.
Patients at a rehabilitation center in Derbyshire, England, were asked to assess their own functional abilities at admission and again at discharge, using an 82-item questionnaire concerning 12 areas of daily living. Questionnaire responses were correlated with results of physical examinations, assessments by center personnel, and assessments of capacity for specific body movements. The highest correlations were observed in areas that related most directly to physical movements and to dressing and toileting. The results suggest that self-assessment of health status using this questionnaire may provide a viable alternative to judgments made by trained assessors. (+info)
Predicting self-assessed health status: a multivariate approach.
Two-stage multivariate analysis was used to examine factors affecting personal perception of health status. In the first stage, sociodemographic variables were used as independent variables in Automatic Interaction Detector (AID) analysis in order to partition the study sample (11,153 civilian noninstitutionalized adults aged 58-63) into subgroups. In the second stage, binary multiple regression analysis was performed on each AID subgroup and on the total sample. Predictors used were indicators of psychological, socioeconomic, and sociomedical well-being. Finally the applicability of these indicators in classifying persons in one of the two categories of perceived health status was examined by discriminant function analysis. Sociomedical health indicators were better explanatory variables of self-assessed health status than socioeconomic or psychological indicators of well-being. (+info)