Reflecting and learning: A grounded theory on reframing deficit views of young indigenous women and safety

Abstract

Often young indigenous women are framed in ways that problematize and pathologize them, which overlooks their strengths. We interviewed 16 young Indigenous Māori women aged 14 to 18 years about their understandings of safety, being safe, and how they kept themselves and their friends safe. Reflecting and Learning, aided by progressing age and maturity, is the process that mediated their feeling unsafe and keeping safe and resulted in being safe. Young Māori women’s reflecting and learning facilitates relatively mature levels of resourcefulness for navigating being safe, including situations they encountered appear unsafe.     

Knowledge of and Agreement with Chronic Pain Diagnosis: Relation to Affective Distress, Pain Beliefs and Coping, Pain Intensity, and Disability

Many authors report that a high percentage of patients with chronic pain have no or insufficient underlying physical pathology to explain their pain. Even when patients do have an identified diagnosis, many patients profess to have little understanding of the source of their pain or fear that they may suffer from more severe pathology. This may be particularly true for patients with chronic musculoskeletal pain given the lack of objective findings for soft tissue pain complaints. In the present study, we examined whether chronic neck and back pain patients were able to identify the physiologic source of their pain, and based on their responses patients were placed in one of three groups: (1) patients who did not know the cause of their pain; (2) patients who did know the cause and agreed with their clinical diagnosis; and (3) patients who identified a cause for their pain that was different from their clinical diagnosis. The sample was comprised primarily of individuals with musculoskeletal pain problems (70%) referred to an outpatient chronic pain rehabilitation program. Each patient completed a pretreatment test battery, and group differences were examined on responses to the McGill Pain Questionnaire, Survey of Pain Attitudes, Brief Symptom Inventory, Coping Strategies Questionnaire, and Pain Disability Index. Upon initial evaluation, 47.2%(n = 85) of patients indicated that they did not know what was causing their pain. Of patients who articulated a cause for their pain, 20%(n = 36) attributed it to factors that did not agree with their diagnosis. Only 32.8%(n = 59) of persons in the entire sample were able to accurately identify the cause of their pain. Patients who disagreed with their clinical diagnosis were more likely to be diagnosed with musculoskeletal pain and reported the highest levels of pain(F(2,169) = 3.41, p > .05) as well as the greatest levels of affective distress(F(2,169) = 3.54, p > .05). Patients who were unsure of or disagreed with their diagnosis tended to report a greater belief in pain being a signal of harm(F(2,169) = 11.5, p > .001) and described themselves as more disabled(F(2,169) = 8.43, p > .001). In addition, both the unsure and disagree groups tended to use maladaptive pain strategies more frequently, and persons unsure of their diagnosis had the lowest levels of perceived control over pain. A hierarchical regression analysis examining a cognitive/behavioral model of pain disability indicated that lack of knowledge of pain etiology, a belief that pain is a signal of harm, catastrophizing and affective distress all significantly predicted increased disability, while pain intensity did not. The data suggests that lack of knowledge about the origin of pain is associated with maladaptive cognitions in relation to pain (i.e., fear of harming oneself and catastrophizing) and increased emotional distress which in turn are related to heightened disability due to pain. These data argue that educating patients regarding their diagnosis and the origin of their pain, thereby dispelling dysfunctional pain beliefs, may be an important component of pain treatment, particularly among patients with chronic musculoskeletal pain.     

Retention and attrition in a home visiting programme: looking back and moving forward

Objective: The purpose of this study was to investigate retention and attrition in First Teacher, Alabama’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. Methods: Secondary data analysis was used to identify families that were most likely to leave through attrition; focus groups were conducted to discuss potential reasons for choosing to leave or stay in the programme. Results: Participants who were pregnant and under the age of 21 years were nearly eight times more likely to leave the programme than their peers. Focus group participants confirmed that it was frequently the relationship with their home visitor that influenced their decision to stay in the programme rather than leave. Conclusion: Based on social exchange theory, investigators observed that home visitors who seemed most successful at building and maintaining relationships with their clientele were women who expanded participant networks through an exchange of information and access to community resources.     

The role of self-help voluntary associations for women empowerment and social capital: the experience of women's iddirs (burial societies) in Ethiopia

Mutual help is essential to the human race to progress to a full humanity. Participating in voluntary associations has multiple benefits and makes a bigger contribution to resiliency in socio-economically deprived neighborhoods. Therefore, the objective of the study is to assess the role of women’s iddirs (burial societies) in promoting their lives, particularly in terms of their social and economic well-being. We employed a quantitative cross-sectional survey. The study population from which the survey data were collected was members of five women’s iddirs’. Majority of them (52.5%) reported that their iddirs helped them to a great extent to become more connected with the people in their local community and 36.4% reported that their confidence has increased to have their own say. Nearly three-fourth (70.3%) of the participants indicated that members were willing to help each other. About 71.6% totally agreed that participation in iddirs alleviates stress and difficulty when a relative or family member dies. Majority of the participants (93.3%) stated that their iddirs didn’t help them to have access to money. All participants (100%) reported that their iddirs don’t have explicitly stated credit mechanisms and nearly all (94.8%) didn’t have any experience of borrowing money from banks. Most study participants appeared to appreciate the social benefits of iddirs much higher than that of their economic benefits. This suggests that iddirs need to be well-organized and co-operate with each other and ensuring flexible lending and interest payment criteria need to be established logistically to serve the needs of the poor members.     

Physicians’ attitudes about communicating and managing scientific uncertainty differ by perceived ambiguity aversion of their patients

Background Medical interventions are often characterized by substantial scientific uncertainty regarding their benefits and harms. Physicians must communicate to their patients as part of the process of shared decision making, yet they may not always communicate scientific uncertainty for several reasons. One suggested by past research is individual differences in physicians’ tolerance of uncertainty. Relatedly, an unexplored explanation is physicians’ beliefs about their patients’ tolerance of uncertainty. Design To test this possibility, we surveyed a sample of primary care physicians (N = 1500) and examined the association between their attitudes about communicating and managing scientific uncertainty and their perceptions of negative reactions to uncertainty by their patients. Physician perceptions were measured by their propensity towards pessimistic appraisals of risk information and avoidance of decision making when risk information is ambiguous – of uncertain reliability, credibility or adequacy, known as ‘ambiguity aversion’. Results Confirming past studies, physician demographics (e.g. medical specialty) predicted attitudes toward communicating scientific uncertainty. Additionally, physicians’ beliefs about their patients’ ambiguity aversion significantly predicted these preferences. Physicians who thought that more of their patients would have negative reactions to ambiguous information were more likely to think that they should decide what is best for their patients (β = 0.065, P = 0.013), and to withhold an intervention that had uncertainty associated with it (β = 0.170, P < 0.001). Discussion When faced with the task of communicating scientific uncertainty about medical tests and treatments, physicians’ perce‐ptions of their patients’ ambiguity aversion may be related to their attitudes towards communicating uncertainty.     

The Association Between Adolescent Smokers' Desire and Intentions to Quit Smoking and Their Views of Parents' Attitudes and Opinions about Smoking

Objective: To explore whether an association exists between adolescent smokers’ attitudes toward quitting and their beliefs about whether their parents know they smoke, their perceptions of whether their parents disapprove of smoking, their recollection of their parents’ expressed disapproval of smoking, and the importance they place on their parents’ opinions. Methods: This cross sectional study of US high school students included 17,287 respondents. Only those who had smoked in the past 30 days (4593 [26.6%]) were included in the analysis. “Have you ever seriously thought about quitting smoking?” was asked of all adolescent smokers. Those who had seriously thought about quitting were then asked about past attempts and how recent their last attempt was, while those who had not seriously thought about quitting were asked if they thought they would ever want to quit. Results: Regardless of whether their parents smoked, adolescents who placed value on their parents’ opinions were more likely to think seriously about quitting and to have tried to quit in the past 6 months. Recalling parents’ expressed desire that their child not smoke was associated with significant increases in the likelihood of seriously thinking about quitting even among those whose parents smoked. Agreeing with the statement, “When I’m older, my parents won't mind that I smoke” was significantly associated with decreased odds of seriously thinking about quitting and recently attempting to quit. Conclusions: Parents, both those who smoke and those who do not, may have a significant role in influencing young smokers’ desire to quit smoking.     

The Good,the Bad,and the Ugly: Divorced Mothers' Experiences With Coparenting

This study produces a grounded theory of how 20 predominantly White, well‐educated women experienced sharing physical custody of their children with their former partners after divorce or separation. Three patterns of coparenting were identified in the data: continuously contentious, always amicable, and bad to better. Five negative factors and three positive factors that influenced mothers' coparenting relationships were identified. The type of relationship women had with their ex‐partners was related to how they shared custody of their children (e.g., how they exchanged their children). The findings of this study suggest that shared physical custody relationships are dynamic and can vary greatly.     

General Practitioners and Hospital-Initiated Prescribing

Objectives: Prescribing costs have risen significantly over the past decade and this has led to increasing pressure on general practitioners (GPs) to control their prescribing budgets. This paper explores GPs' perceptions of the influences of hospital-initiated prescribing on how they manage their prescribing budget.

Method: 16 practices within Birmingham Health Authority were selected according to characteristics of their prescribing budget. Twenty-one GPs in these practices were interviewed in depth about their views on how they controlled their prescribing budget, including questions on hospital-initiated prescribing.

Results: GPs reported being influenced by the experience of seeing patients who had been prescribed particular drugs by a consultant and then following their example. However, GPs expressed dissatisfaction with some hospital-initiated prescribing. Sometimes they considered the choice of drugs for conditions commonly treated in primary care to be unnecessarily expensive. They were also concerned about more expensive and more specialist drugs. GPs found it difficult to change or refuse to prescribe medication which had been initiated in hospital because they felt it could be damaging to their relationship both with their patients and consultants.

Conclusions: Hospital prescribing can have a major impact on general practice budgets and GPs felt that their ability to contain costs was not always within their control. The GPs expressed a wide range of views on how to respond to prescribing initiated in hospital with which they did not feel comfortable.     

Lead Exposure Among Decorative and House Painters

Fumigation with air containing 0.075 ppm formaldehyde for one hour reduces the rate of photosynthesis and respiration of Euglena cells. “Fasting” of the cells for 4.5 hours in bicarbonate buffer prior to fumigation with 0.075 ppm formaldehyde causes a slight increase of their rate of photosynthesis and respiration. Exposure of the Euglena cells to air containing 0.100 ppm propionaldehyde for one hour diminishes their rate of photosynthesis and respiration. Almost complete protection from the toxic effects of 0.100 ppm propionaldehyde is offered by fasting the cells for 4.5 hours in bicarbonate buffer. By comparing the effect of formaldehyde on photosynthesis and respiration of Eugtena gracilis with that of propionaldehyde, we find that propionaldehyde is the more toxic one, and that fasting of the cells reduces their sensitivity to the effects of both aldehydes.     

Patient Beliefs and Sense of Control Among Spanish-Speaking Patients with Diabetes in Northeast Colorado

Purpose Latinos have higher diabetes prevalence and complication rates with lower use of self-management compared to other populations. This study evaluated perceived barriers to diabetes control among Spanish-speaking only patients in rural Colorado. Methods Thirty-five Spanish-speaking patients with diabetes were randomly sampled and interviewed about their attitudes and beliefs concerning diabetes, self-management activities, and the care they received. Results Patients perceived a high level of control over their diabetes. A minority of patients were adherent to recommended dietary changes or levels of exercise. Use of herbal home remedies to maintain glycemic control was common. Almost half of respondents felt that susto played a role in the development of their diabetes. Three fourths of those testing their glucose felt their physician was not interested in reviewing their blood sugar log. Conclusions Diabetes management programs should recognize the barriers patients may have to self-management and help patients incorporate traditional beliefs into a workable treatment regimen.     

Synthesis and trazodone-like pharmacological profile of 1- and 2-[3-[4-(X)-1-piperazinyl]-propyl]-benzotriazoles

A series of 1- and 2-[3-[4-(X)-1-piperazinyl]-propyl]benzotriazoles were prepared and evaluated for their trazodone-like pharmacological profile; as preliminary pharmacological screening, the compounds were tested for their antiserotonergic, antiadrenergic and antihistaminic in vitro activity as well as for their analgesic in vivo action. Structure-activity relationships showed that among the synthesized compounds, the analogues bearing on the 4-piperazine nitrogen either an unsubstituted phenyl ring or a 2- or 3-chloro phenyl moiety show a pharmacological profile similar to that of the antidepressant trazodone.     

The Effect of Pregnancy Intention on Important Maternal Behaviors and Satisfaction with Care in a Socially and Economically At-Risk Population

This study examined the association of pregnancy intention with maternal behaviors and the woman’s perceived satisfaction with her prenatal and delivery care. Face-to-face interviews with 478 primarily Medicaid eligible women in Indianapolis, Indiana during their postpartum hospital stay were conducted to assess their degree of satisfaction with prenatal care and pregnancy intention, stratified into wanting to be pregnant now, later or never. Behaviors and characteristics influencing utilization of prenatal care were obtained from linked birth certificate data. A greater proportion of younger women (15–29) wanted to be pregnant later, a greater proportion of African-Americans never wanted to be pregnant, a greater proportion of divorced and never married women wanted to be pregnant later or never, and as parity increased the percentage of women never wanting to be pregnant increased. Multivariate analyses found that women never wanting to be pregnant were twice as likely to underutilize prenatal care, twice as likely to smoke while pregnant, half as likely to utilize WIC services and half as likely to recommend their providers to pregnant friends or relatives compared to women with a planned pregnancy, controlling for confounding variables. Finally, women wanting to be pregnant later were half as likely to rate their overall hospital care and prenatal care provider as high. Providers assessing their patients’ pregnancy intention could better identify those women needing additional support services to adopt healthier behaviors and improve satisfaction with care. This study also demonstrated the value of more specific definitions of pregnancy intention.     

Supplementary Analyses Regarding Langevin,Langevin, and Curnoe’s (2007) Findings on Fraternal Birth Order in Homosexual Men

A recent article by Langevin, Langevin, and Curnoe (2007) reported mixed results regarding the fraternal birth order effect, that is, the repeatedly observed finding that older brothers correlate with homosexuality in later-born males. Using a fraternal birth order index computed as older brothers minus younger brothers, Langevin et al. found that the “homoerotic” probands were born later among their brothers than were the “heteroerotic” probands in their full sample (N = 1194) and in their subsample over age 19 (N = 1122), but not in their subsample over age 31 (N = 698) or in their subsample with mothers over age 46 at the proband’s birth (N = 727). The present writer concluded that the results obtained with the larger samples are more reliable, based on analyses demonstrating that (1) the larger samples are unlikely to be seriously affected by incomplete sibships, and (2) the smaller samples have poor statistical power. A separate analysis, based on an approximate reconstruction of Langevin et al.’s raw data, indicated that their heteroerotic probands reported a ratio of 104 older brothers per 100 older sisters, which is close to the normative population value of 106, whereas their homoerotic probands reported a ratio of 137, indicating a statistically significant excess of older brothers. These results suggest that Langevin et al.’s data showed significant evidence of a fraternal birth order effect and that their data were consistent with previous studies of this phenomenon.     

Comparative evaluation of oxidative stress status and manganese availability in plants growing on manganese mine

This study pioneered an approach that determined the effects of excess manganese (Mn) on three species; Datura stramonium, Alhagi camelthorn and Chenopodium ambrosioides. We investigated their levels of Mn, antioxidative enzymes and oxidative damage biomarkers in plants (zone 1) in and outside (zone 2) the Mn mine. The results showed that total and available Mn were at toxic levels for plants growing on zone 1. The Mn levels in each plant species were higher in leaves, stems and roots. Mn was only accumulated significantly in leaf vacuoles of A. camelthorn. Antioxidative enzyme activities of C. ambrosioides and/or D. stramonium in zone 1 were higher in leaves, stems and then in their roots. Malondialdehyde (MDA) and dityrosine levels were insignificantly higher in tissues of the studied plants in zone 1 with respect to zone 2. The roots of studied plants showed significantly higher levels of these biomarkers in comparison with their leaves in zone 1. Accordingly, antioxidative enzymatic response to Mn-stress in D. stramonium and C. ambrosioides and possibly accumulation of Mn in leaf vacuoles of A. camelthorn, protected them from oxidative damages and involved in their tolerance in Mn mine.     

Pediatric Residency Training and the Needs of Gay, Lesbian, and Bisexual Youth

Objective: This study surveys the education of pediatric residents about the needs of gay, lesbian, and bisexual (GLB) youth. The report measures the extent to which such training is considered valuable by those responsible for its administration and it evaluates the awareness of community referrals for GLB youth. Methodology: U.S. pediatric residency directors and chief residents were surveyed using a questionnaire designed by the authors. Percentage tabulation of the questions was performed. Chi-square analysis of two questions was done to determine if there was an association between the responses given and whether or not a respondent was from a program that offered training to their residents. Results: Over half of the respondents indicated that their programs offered training in the care of GLB youth. This increased to over three fourths when those respondents who indicated that their program was planning such training efforts were included. There was a broad distribution in the form and prevalence of training techniques. Over 90% of the respondents indicated that they valued the inclusion of GLB youth issues into residency curricula. A lesser majority indicated an awareness of community referrals for GLB youth. Conclusions: A large majority of pediatric residencies are either training their residents about the needs of GLB youth or are developing such training opportunities. The form and extent of the training varies widely. As such, the continued development of educational approaches and evaluation measures are encouraged.     

Identity Formation in Adolescents from Italian,Mixed, and Migrant Families

The purpose of this study was to compare identity formation in adolescents from Italian (n = 261), mixed (n = 100), and migrant families (n = 148). Participants completed the Italian version of the Utrecht-Management of Identity Commitments Scale that assesses identity processes in educational and relational domains. Within a variable-centered approach we found that adolescents from migrant families reported significantly higher levels of reconsideration of commitment than did their peers from Italian and mixed families. Similarly, within a person-centered approach, adolescents from migrant families were more represented in the searching moratorium status than their counterparts from Italian and mixed families. Overall, these results indicated that migrant adolescents face more difficulties to define their personal identity.     

Functional Interpretations of Sadness,Stress and Demoralization among an Urban Population of Low-Income Mothers

Objectives We sought to understand how low-income urban mothers explain feelings of sadness, stress or demoralization in the context of their life experiences. Methods 28 in-depth qualitative interviews, constituting part of a community-based participatory research (CBPR) project aimed at developing a culturally relevant, community-based intervention for maternal depression. Qualitative data validity was ensured through investigator and expert triangulation, and through member checking. Results The following themes emerged: (1) Informants spoke of wanting reprieves from chaos, and discussed this desire relative to wanting to be alone. By contrast, informants expressed loneliness not only in interpersonal terms, but also related to having problems that precluded future relationships, or feeling unique in experiencing an adversity. (2) Informants spoke of demoralization associated with feeling that their problems were externally imposed and therefore beyond their control, but spoke of empowerment associated with owning one’s problems. (3) Informants discussed degrees of sadness in relation to their own abilities to adjust or modify their mood, or their ability to contain their feelings. Conclusions Our data suggest that helping a mother find reprieves from chaos, increasing her perception of her own locus of control around externally imposed adversities, and empowering her to recognize and self-manage her own feelings may constitute important elements of a culturally relevant, community-based intervention for depression.     

Students Teaching Students: Learning Through Doing,Being, and Becoming

This paper describes a creative teaching strategy that may be used by occupational therapy educators. The strategy is illustrated through the learning experience of five occupational therapy students in Pi Theta Epsilon (PTE) who participated in a project which involved teaching first year occupational therapy students. With guidance from their faculty advisor, the students developed a lecture on Occupational Science and designed a pre and posttest instrument to measure the first year student's learning as well as their own performance and learning. Qualitative data from the five PTE students provided insight into their teaching experience. This project afforded an opportunity for the five students to apply and strengthen their problem-solving, interpersonal, and leadership skills, and teamwork. The doing aspect of preparing a lecture required various skills and knowledge that will benefit the students as future practitioners. The actual teaching of others allowed the students to experience being in the role of an educator. Such learning activities help to prepare students for their journey to becoming occupational therapists.