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)
What is the future for equity within health policy?
In spite of differences in meaning, equity is generally accepted as an important social and economic policy goal. However, recent policy debates suggest that this consensus is under challenge. This paper explores the current debate between the 'New Right' and its opponents, and how different approaches affect health policy. It is strongly argued that if equity is not to remain a misunderstood concept, it is essential to clarify the arguments in its favour, as well as the steps required to protect its position within policy. The paper then goes on to justify the concern with equity, the broad goals equity seeks to achieve, and the practical translation of these goals into health policy. In the final section essentially practical issues are raised, by considering planning strategies and what research is necessary to support and develop pragmatic planning based on equity goals. (+info)
Strategic physician communication and oncology clinical trials.
PURPOSE: Clinical trials are the primary means for determining new, effective treatments for cancer patients, yet the number of patients that accrue is relatively limited. The purpose of this study was to explore the relationship between physician behavior and patient accrual to a clinical trial by videotaping the interaction. PATIENTS AND METHODS: Forty-eight patient-physician interactions involving 12 different oncologists were videotaped in several clinics at the H. Lee Moffitt Cancer Center and Research Institute (Tampa, FL). The purpose of each interaction was to present the possibility of a clinical trial to the patient. A coding system, the Moffitt Accrual Analysis System, was developed by the authors to code behaviors that represented both the legal-informational and social influence models of communication behavior. Thirty-two patients agreed to participate in the clinical trial. RESULTS: Videotaping was found to be a viable, valid, and reliable method for studying the interaction. Physicians who were observed to use both models of influence were found to enroll more patients. Thus, patients were more likely to accrue to the trial when their physician verbally presented items normally included in an informed consent document and when they behaved in a reflective, patient-centered, supportive, and responsive manner. Discussion of benefits, side effects, patient concerns and resources to manage the concerns were all associated with accrual. CONCLUSION: This research has implications for modifying physician behavior and, thus, increasing the numbers of patients accruing to oncology clinical trials. (+info)
Exploring the scope for advocacy by paediatricians.
AIMS: To ascertain the type and extent of problems requiring advocacy in paediatrics. To develop an approach for analysing problems according to their root causes and the level of society at which advocacy is needed. METHODS: Nine paediatricians kept detailed clinical diaries for two weeks to identify problems. Classifications were developed to categorise problems by cause and the level of society at which they needed to be addressed. The press was surveyed for one week for childhood issues attracting media attention. RESULTS: 60 problems requiring advocacy were identified. Root causes included failures within agencies, between agencies, and inadequate provision. In addition to advocacy required individually, "political" action was needed at the community level (16 issues), city level (16 issues), and nationally (15 issues). 103 articles were found in the press, these did not relate closely to issues identified by clinicians. CONCLUSIONS: Many opportunities for advocacy arise in the course of daily work. A systematic way of analysing them has been developed for use in planning action. To optimise the health and health care of children, there is a need to train and support paediatricians in advocacy work for local as well as national issues. Ten issues were identified that might be prioritised by paediatricians working on an agenda for action. (+info)
Cardiovascular risk factors and the neighbourhood environment: a multilevel analysis.
BACKGROUND: This article examines whether the neighbourhood environment influences intermediate cardiovascular disease (CVD) risk factors, such as obesity (body mass index [BMI]), and lifestyle factors, such as no physical activity and smoking, when adjusted for the individual socioeconomic status (SES). METHODS: The study consists of face-to-face interviews from the Swedish Annual Level of Living Survey (SALLS) matched with the social status of the respondents' residential areas measured by two composite indices, the Care Need Index (CNI) and the Townsend score. The response rate was about 80%. This study was limited to the residents aged 25-74 years and consists of 9240 interviews from the years 1988-1989, when there were extended items in the SALLS about health and lifestyle. The data were analysed using a hierarchical logistic regression model. RESULTS: There was a gradient within every SES group so that respondents with a low (or intermediate or high) educational level exhibited an increasing proportion of daily smokers, physically inactive people and obese individuals with increasing neighbourhood deprivation. The multilevel model showed that respondents living in the most deprived neighbourhoods had an increased risk for being a daily smoker, engaging in no physical activity and being obese when adjusted for the individual SES. CONCLUSIONS: We showed that the area level has an important influence on risk factors for CVD which goes beyond the individual educational attainment. An increased level of living standard, more resources for primary health care and health promotion targeting the community level should be beneficial. (+info)
Social background, adult body-height and health.
STUDY OBJECTIVE: To study the socio-demographic determinants of body-height and the bearing of these determinants on the association between body-height and health among Finnish adults. DATA AND METHOD: Cross-sectional population survey including questions on social background, body-height and health, and retrospective questions on childhood living conditions. The data derive from a representative Survey on Living Conditions collected by Statistics Finland in 1994. The response rate was 73%. Male and female respondents > or =20 years were included in the analysis (N = 8212). Statistical methods include regression analysis and logistic regression analysis. RESULTS: Body-height was strongly associated with year of birth, region, childhood living conditions and education among adult men and women. Body-height was also associated with limiting long-standing illness and perceived health as below good. Tall men had the best health and short men the poorest health. Among women the association of body-height with health differed from men, as tall women showed high levels of limiting long-standing illness, notably musculo-skeletal diseases. Adjusting for the background variables weakened but did not abolish the association between poor health and short stature among men and women. CONCLUSIONS: Short stature is associated with poor health among Finnish men and women. A non-linear association among women was found for musculo-skeletal diseases. The studied social background factors explained only little of the association between body-height and health. (+info)
The environmental genome project: ethical, legal, and social implications.
The National Institute of Environmental Health Sciences is supporting a multiyear research initiative examining genetic influences on environmental response. Proponents of this new initiative, known as the Environmental Genome Project, hope that the information learned will improve our understanding of environmentally associated diseases and allow clinicians and public health officials to target disease-prevention strategies to those who are at increased risk. Despite these potential benefits, the project presents several ethical and social challenges. Of immediate concern is the protection of individual research participants. Other ethical issues relate to the application of research results and how study findings could affect social priorities. Clarifying these emerging areas of concern, many of which have not received adequate attention in the existing bioethics literature, is an important step toward minimizing potential research-related risks and defining research needs. (+info)
Why reduce health inequalities?
It is well known that social, cultural and economic factors cause substantial inequalities in health. Should we strive to achieve a more even share of good health, beyond improving the average health status of the population? We examine four arguments for the reduction of health inequalities.1 Inequalities are unfair. Inequalities in health are undesirable to the extent that they are unfair, or unjust. Distinguishing between health inequalities and health inequities can be contentious. Our view is that inequalities become "unfair" when poor health is itself the consequence of an unjust distribution of the underlying social determinants of health (for example, unequal opportunities in education or employment).2 Inequalities affect everyone. Conditions that lead to marked health disparities are detrimental to all members of society. Some types of health inequalities have obvious spillover effects on the rest of society, for example, the spread of infectious diseases, the consequences of alcohol and drug misuse, or the occurrence of violence and crime.3 Inequalities are avoidable. Disparities in health are avoidable to the extent that they stem from identifiable policy options exercised by governments, such as tax policy, regulation of business and labour, welfare benefits and health care funding. It follows that health inequalities are, in principle, amenable to policy interventions. A government that cares about improving the health of the population ought therefore to incorporate considerations of the health impact of alternative options in its policy setting process.3 Interventions to reduce health inequalities are cost effective. Public health programmes that reduce health inequalities can also be cost effective. The case can be made to give priority to such programmes (for example, improving access to cervical cancer screening in low income women) on efficiency grounds. On the other hand, few programmes designed to reduce health inequalities have been formally evaluated using cost effectiveness analysis. We conclude that fairness is likely to be the most influential argument in favour of acting to reduce disparities in health, but the concept of equity is contested and susceptible to different interpretations. There is persuasive evidence for some outcomes that reducing inequalities will diminish "spill over" effects on the health of society at large. In principle, you would expect that differences in health status that are not biologically determined are avoidable. However, the mechanisms giving rise to inequalities are still imperfectly understood, and evidence remains to be gathered on the effectiveness of interventions to reduce such inequalities. (+info)