The adaptation of mothers of children with intellectual disability in Lebanon.

In many Middle Eastern countries, including Lebanon, there is a stigma attached to families who have an intellectually impaired child. These families complain of isolation and lack of community resources that could help them cope with their circumstances to optimize the child's abilities. Health professionals and researchers should be cognizant of factors related to the process of stress adaptation to help families cope with their circumstances. The aim of this cross-sectional study was to identify factors that play a role in mothers' adaptation to the care of their intellectually impaired children. The results, based on a sample of 127 mothers from Lebanon, reveal that a high percentage of mothers had depressive symptoms. Multiple regression analysis demonstrates that by order of importance, the factors that determine maternal depression are family strain, parental stress, and family income. The conclusions about nursing implications from a cultural perspective are discussed and recommendations proposed.     

Relationships between psychosocial factors and abusive parenting attitudes in low-income single mothers

BACKGROUND: Linkages among family violence, maternal mental health, and parenting attitudes are not clearly understood. OBJECTIVE: To investigate the relationships of abuse (childhood and/or partner), everyday stressors, self-esteem, depressive symptoms, and anger with abusive parenting attitudes. METHOD: Cross-sectional analysis of data collected in interviews with 53 low-income, single mothers from wave two of a 3-wave study. A conceptual framework and bivariate correlations guided a series of multiple regressions to identify the best predictors for each variable. RESULTS: A high prevalence of abuse, depressive symptoms, and abusive parenting attitudes was found. Few women had ever received mental health treatment. Abuse (partner and childhood physical) predicted higher everyday stressors which in turn predicted lower self-esteem. Childhood abuse and lower self-esteem predicted more depressive symptoms. More depressive symptoms were related to higher levels of state anger. More everyday stressors and more depressive symptoms predicted higher levels of trait anger. Higher levels of anger expression were associated with higher everyday stressors and lower self-esteem. The presence of partner abuse best predicted higher levels of overall abusive parenting attitudes and more parent-child role reversal. Less parental empathy was associated with higher levels of state anger. CONCLUSIONS: This study partially explains the relationships of maternal abuse history and mental health status with parenting attitudes. Other predictors of parenting attitudes remain to be identified. The findings underscore the need for healthcare providers to consider the mental health status and abuse histories of low-income, single mothers. The potential disturbance in the parenting process of single mothers in abusive relationships warrants further investigation.     

Adult T-cell leukemia/lymphoma in the Middle East: first report of two cases from Lebanon

BACKGROUND: Adult T-cell leukemia/lymphoma (ATL) is an aggressive lymphoproliferative disorder caused by human T-cell leukemia virus type I (HTLV-I). HTLV-I is endemic in southern Japan, the Caribbean, Central and South America, certain areas of Africa, and the southeastern United States. In the Middle East, North East Iran, particularly the region of Mashhad, has been recognized as an endemic region.
CASE REPORTS: In this report, the first two cases of ATL diagnosed in Lebanon are described. The first patient of Lebanese origin presented with acute ATL. The second patient of Romanian origin developed acute ATL in early relapse after autologous transplantation for ATL. Both patients had lymphocytosis, severe hypercalcemia, and CD25+ T-cell immunophenotype on peripheral blood. In both patients, HTLV-I serology was positive by enzyme-linked immunosorbent assay and confirmed by Western blot and HTLV-I oncoprotein Tax expression was documented in the leukemic cells. Upon screening, seven direct family members of the first patient were HTLV-I positive; four of them were regular blood donors.
CONCLUSIONS: Screening blood donors for HTLV-I seropositivity is not currently performed in Lebanon. A large screening study in Lebanon is needed to confirm whether South Lebanon is a new endemic region for HTLV-I infection and to recommend mandatory screening of blood donors for HTLV-I infection.     

Calculating Number of Offenses and Victims of Juvenile Sexual Offending: The Role of Posttreatment Disclosures

This research was designed to compare data obtained from agency records at three treatment programs for juvenile male sex offenders with information available from clinicians once youth and their families had been in treatment for at least 6 months. Results revealed that over the course of treatment, youth and their families disclosed information about additional victims and offenses, physical and sexual abuse of the offenders, and several aspects of a violent and sexualized family environment. Over half the boys reported additional victims or additional offenses or both. There were significant increases in the number of reports of physical abuse, witnessing of domestic violence, living in a sexual environment, maternal sexual victimization, maternal victimization of domestic violence, and fathers being perpetrators of domestic violence. These data clearly support the hypotheses of the study and have important implications for both clinical practice and future research in this area.     

Intersection of child abuse and children's exposure to domestic violence

This review addresses research on the overlap in physical child abuse and domestic violence, the prediction of child outcomes, and resilience in children exposed to family violence. The authors explore current findings on the intersection of physical child abuse and domestic violence within the context of other risk factors, including community violence and related family and environmental stressors. Evidence from the studies reviewed suggests considerable overlap, compounding effects, and possible gender differences in outcomes of violence exposure. The data indicate a need to apply a broad conceptualization of risk to the study of family violence and its effects on children. Further testing of competing theoretical models will advance understanding of the pathways through which exposure leads to later problems in youth, as well as protective factors and processes through which resilience unfolds.     

Confronting the Monster of Family Violence

Family violence has been a harrowing manifestation stalking the lives of families, resulting in physical, emotional, and sexual abuse predominately among women and children. This article identifies beliefs that disregards domestic violence, outlines characteristics of abused persons, and describes primary and secondary prevention strategies. The author outlines the role of nurses to provide preventive education, do case finding, and assist their community to confront family violence through professionally, socially, and personally responsible actions.     

Young people living with parental alcohol misuse and parental violence: ‘No‐one has ever asked me how I feel in any of this’

Young people are adversely affected by negative family experiences, but there is a gap in knowledge when the commonly co‐existing issues of parental alcohol misuse and parental domestic abuse are considered. Research which talks directly to the young people living in such circumstances is therefore needed. As part of a Europe‐wide research study, eight young people aged 12–18 years from five families in England were interviewed about their experiences of living with parental alcohol misuse and violence. Strong links emerged between parental drinking and domestic abuse, with verbal aggression common, and frequent and physical violence less frequent, but of equal concern. The young people had tried and were trying a range of strategies to try and cope with their home environments, and faced an ongoing battle in working out what to do for the best. Support from family, friends, and professionals was discussed, but the young people generally had mixed views about what help they had received and the support that they would have liked. The paper discusses what the findings might mean in terms of the practice and policy response to children living in risky family environments.     

Testing a model of family stress and coping based on war and non-war stressors, family resources and coping among Lebanese families.

This study was undertaken to describe the objective stressors, perceived stress, coping, and resources of families living in Beirut during the Lebanese war (1975-1991) and to test a model predicting the relationships of these variables to family adaptation. The sample consisted of 438 families chosen at random. Independent variables included objective stressors and perceived stress. The mediating variables were family resources and coping strategies. The dependent variables were health and interactional indicators of family adaptation: physical and psychological health, depression, and interpersonal and marital relationships. Findings provided support for the theoretical framework. Multiple regression analyses revealed that perceived stress, rather than the objective occurrence of events, predicted family adaptation. Family resources, particularly social support, positively impacted family adaptation and was associated with increased use of cognitive coping. The findings provide a theoretical model which, on further testing, can serve as a basis for practice by health professionals when working with traumatized families.     

The health of family caregivers of older impaired persons in Lebanon: an interview survey

BACKGROUND: The majority of older persons in Lebanon live with their family, which provides the help and care required when their relative is functionally impaired. Knowing that taking care of an older impaired relative is considered a source of enrichment for the caregiver and an act of gratitude towards the older person in Lebanon. However, there are few formal resources to support these families. This study is informed by a theoretical framework of stress. OBJECTIVE: Identify the dimensions of the caring context related to the health of Lebanese family caregivers living with an older impaired relative. DESIGN: Exploratory correlational study. PARTICIPANTS: Convenience sample (N=319) drawn from all the regions of Lebanon according to predetermined quotas on the basis of relative demographic weight and socio-economic class. The inclusion criteria are: aged 18 years or over; primary caregiver; provided help with at least one ADL or IADL once a week; lived with the older impaired person. 13.5% refused to participate in the study. The caregivers recruited were female (84%), adult children (48%) or spouses (22.6%) with a mean age of 46 years. Almost half of them reported a post-compulsory level of education and a low monthly household income and no medical coverage for 68% of them. METHODS: The data were collected during a face-to-face interviews with the caregivers in their homes. RESULTS: The results from regression analyses indicate that the degree of functional impairment, the frequency of depressive and disruptive behaviours of cared-for relative are linked to at least one of three caregiver health indicators (p<.01). Also, caregiver cognitive appraisal of these stressors is associated with either role strain or feeling of helplessness (p<.05). The informal emotional support received by caregivers is positively related to well-being (p<.001), whereas interpersonal conflicts with family and friends diminish caregiver well-being and increase role strain (p<.001). Sufficiency of emotional support received is negatively associated with role strain (p<.001). CONCLUSION: Many stressors proved associated with one or other of the health indicators under study and the resources emerged as significant factors related to caregiver's health.     

Caring for abused women: impact on nurses' professional and personal life experiences

Title.  Caring for abused women: impact on nurses' professional and personal lifeexperiences.
Aim.  This article is a report of a study of the impact of caring for abused women on nurses' professional and personal life experiences.
Background.  Encountering abused women can have emotional, cognitive and behavioural influences on nurses, known as vicarious traumatization. They may feel incompetent to deal with such an overwhelming problem and may avoid screening survivors of abuse. Thus, nurses treating these survivors need to be aware of their attitudes, emotions and differential responses during these interactions.
Method.  A phenomenological study was carried out in 2005 in Israel. The data were collected using in-depth, interviews with 22 female Israeli nurses in hospitals and community healthcare clinics.
Findings.  Data analysis revealed one main theme, 'Struggling on work and home fronts', based on two subthemes: 'Encounter with domestic violence: a challenge to nurses' professional role perception' and 'Between work and home'. Nurses experience perplexity regarding abused women and their professional care. Encounters with these women challenge nurses' personal and professional attitudes, as well as influencing their personal lives (intimate relationships, parenthood and gender attitudes). These encounters induce empathy and compassion, but also anger and criticism towards abused women, creating emotional labour for the nurses.
Conclusion.  The dissonance between personal values, attitudes and emotions and the desirable professional intervention procedures might impede nurses' performance in caring for abused women. Implementing training programmes for screening and intervening with abused women might reduce the emotional labour required, enhance nurses' responses to domestic violence, and enable personal growth.     

Going alone: the lived experience of female Arab-Muslim nursing students living and studying in the United States

Since 2004, international student enrollment in the United States has increased. Middle Eastern students studying in the United States have been part of the increase. In 2008-2009 there were 29 140 Middle Eastern students, representing an 18% increase from the previous academic year. Despite these increases, there is limited research examining the experience of Arab-Muslim international students or international nursing students studying in the United States. Phenomenological inquiry was used to describe the experience of 12 female Omani nurses living in the United States while studying for their baccalaureate degrees in nursing. The women described the experience of going alone and being away from the support and presence of their large, extended families; this influenced their international student experience. They also described their religious, cultural, and educational adaptation. The experience of living and studying nursing in the United States was transformational as they became self-reliant, learned their capabilities, and adapted to cultural and educational expectations.     

Cross-cultural factors in disclosure of intimate partner violence: an integrated review

Title.  Cross-cultural factors in disclosure of intimate partner violence: an integrated review.
Aim.  This paper is a report of an integrated review to identify cross-cultural factors that have an impact on women's disclosure of intimate partner violence, specifically related to Mexican-American women.
Background.  Intimate partner violence was once recognized as a private matter. Disclosure is a complex concept; furthermore in our multi-cultural society, a woman's decision whether or not to disclose abuse can be attributed to several factors influenced by her culture.
Data sources.  The World Wide Web and multiple databases including Academic Premier, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsychArticles, PsychInfo, Medline, Eric, MedicLatina, and Psychology and Behavioral Science Collection were searched for studies published between 1996 and 2007.
Methods.  A search was conducted using databases including the CINAHL, PsychINFO, MEDLINE, ERIC and MedicLatina. Both qualitative and quantitative studies published between May 1996 and July 2007 were included. Forty-two studies were included in the review. Appraisal of study quality was not undertaken.
Results.  Fear was the most common cross-cultural factor interfering with disclosure. Most of the literature examines factors influencing and interfering with disclosure of abuse among white and African-American women. Only one study was found to include a sample of Mexican-American women.
Conclusion.  Increased efforts are needed to understand disclosure of intimate partner violence in minority women so that service providers can tailor services and ways to encourage disclosure with appropriate strategies based on women's culture. Further research is needed to understand the lived experiences of minority women, including Mexican-American women living in intimate partner violence.     

Living with breast cancer,a Lebanese experience

AimThe purpose of this qualitative phenomenological study is to provide in-depth understanding of the experience of Lebanese women living with breast cancer.BackgroundBreast cancer is the most frequently diagnosed cancer in women worldwide. In Lebanon, a country of 4 million people, breast cancer is as well the most widespread type of cancer among Lebanese women. The meaning of cancer diagnosis, the meaning of childbearing and femininity all have cultural bases in Lebanon. The international literature lacks information on how Lebanese women live with breast cancer when compared with women of other cultures.MethodThe study followed purposeful sampling and saturation principles in which 10 participants with a mean age of 51.3 years were chosen based on their actual knowledge of the phenomenon, and their readiness to share that knowledge. Data were collected between December 2007 and May 2008. All interviews were audio-taped and transcribed verbatim. Data were analyzed based on the Utrecht School of Phenomenology.FindingsFour major core themes describing the participants' lived experience emerged from the interviews: Living with losses; living with guilt feeling; living with fears and uncertainty; Living with the need to know and to share that knowledge.ConclusionThe experience of Lebanese women with breast cancer revealed distinctive themes not reported by other women from other cultures. The results of this study challenge health care providers and educators to be aware of the difficulties that Lebanese women are facing when they are living with breast cancer.     

Family issues associated with military deployment, family violence, and military sexual trauma

Today's military has a greater percentage of families and children in comparison with previous generations. There are many, and unique, demands on military families made by the ongoing conflicts, and military life can be stressful. The presence of an increasing number of stressors is associated with an increased likelihood of domestic violence in military families and sexual trauma in service members. In this article, literature and research are presented to provide an overview of military deployment and families, and the effect of deployment on families; this is followed by a review of research on family violence and military sexual trauma.     

Intimate partner violence and reproductive health of women in Kenya

Background:  Reproductive age represents an augmented risk of intimate partner violence (IPV) despite its occurrence in women of all ages. IPV has been associated with various reproductive health outcomes (e.g. terminated pregnancies and infant mortality), although multi-country studies indicate that the findings may not be consistent across all cultures.
Study aim and method:  The current work describes the association between IPV and reproductive health of women in Kenya using the Demographic and Health Survey of 2003.
Results:  A significant association between physical/emotional/sexual abuse of women and negative reproductive health outcomes such as terminated pregnancies and infant mortality was identified. In addition, IPV exposure was associated with use of family planning methods and high fertility.
Conclusion and recommendations:  Practitioners in the healthcare sector should inquire about abuse. Provision of counselling services and information regarding IPV effects on reproductive outcomes as well as referring abused women to relevant institutions is recommended in secondary prevention of IPV and to improve the reproductive health status of abused women.