Changes in reciprocal support provision and need-based support from partners of patients undergoing radical prostatectomy

We examined need-related and reciprocal provision of support in couples facing radical prostatectomy and its sequelae, including patients’ urinary incontinence. Partners’ reciprocal support provision to patients was assumed to drop from prior to until after patients’ surgeries and increase again in the following months, while need-related indicators were assumed to remain unique correlates throughout. In this study of German prostatectomy patients and their partners, N = 141 couples provided data on 4 measurement occasions from presurgery to 1-year postsurgery. Need-based predictors of partners’ support provision were patients’ mobilized support, such as efforts to obtain advice or comfort, and degree of postsurgery incontinence. Strength of association between partner-received and provided supports served as an indicator of reciprocal support provision. Data suggested that partners’ reciprocal support provision dropped significantly postsurgery and then increased again in the following months. This was true for emotional as well as instrumental reciprocal support provision. Findings also indicated that one need-based predictor of partners’ support provision, patients’ mobilization of support from their partners, remained a unique correlate of partners’ support provision to patients. Reciprocal support provision in couples may vary during the adaptation to illness-related functional impairment and coexist with need-oriented support provision.     

Caring for children with physical disability in Kenya: potential links between caregiving and carers' physical health

Background The health of a carer is a key factor which can affect the well‐being of the child with disabilities for whom they care. In low‐income countries, many carers of children with disabilities contend with poverty, limited public services and lack assistive devices. In these situations caregiving may require more physical work than in high‐income countries and so carry greater risk of physical injury or health problems. There is some evidence that poverty and limited access to health care and equipment may affect the physical health of those who care for children with disabilities. This study seeks to understand this relationship more clearly. Methods A mixed methods study design was used to identify the potential physical health effects of caring for a child with moderate‐severe motor impairments in Kilifi, Kenya. Qualitative data from in‐depth interviews were thematically analysed and triangulated with data collected during structured physiotherapy assessment. Results Carers commonly reported chronic spinal pain of moderate to severe intensity, which affected essential activities. However, carers differed in how they perceived their physical health to be affected by caregiving, also reporting positive benefits or denying detrimental effects. Carers focussed on support in two key areas; the provision of simple equipment and support for their children to physically access and attend school. Conclusions Carers of children with moderate‐severe motor impairments live with their own physical health challenges. While routine assessments lead to diagnosis of simple musculoskeletal pain syndromes, the overall health status and situation of carers may be more complex. As a consequence, the role of rehabilitation therapists may need to be expanded to effectively evaluate and support carers' health needs. The provision of equipment to improve their child's mobility, respite care or transport to enable school attendance is likely to be helpful to carers and children alike.     

Are partners available for post-abortion contraceptive counseling? A pilot study in a Baltimore City clinic

About half of the 1.2 million abortions each year in the United States are repeat abortions. While most abortion providers counsel women about contraception, one reason for the high repeat rate could be failure to take into account the social context of the women--in particular, the male partner. To assess whether there might be a window of opportunity for a contraceptive intervention that includes the male partner at the time of the abortion, we undertook a pilot study at an urban abortion clinic to examine the role of the male partner among women receiving abortions. Between May 2001 and August 2002, two questionnaires were administered to 109 women receiving abortions in a Baltimore City clinic. On the procedure day, women were more likely to be accompanied by a male partner upon arrival (30%) or when leaving (34%) than by any other individual. The majority of women receiving abortions reported that their partners played positive decision-making and support roles throughout the abortion process. A significant proportion of couples could be available for contraceptive counseling following an abortion, providing rationale for couples' post-abortion contraceptive counseling for women whose partners are already actively and positively involved in the abortion process. Such an intervention may help to reduce repeat abortions.     

Rural general practitioner apprehension about work related violence in australia

Aims: To identify levels of Australian rural general practitioners’ apprehension about violence, factors effecting apprehension and the effect of apprehension on service provision. Method: Six focus groups were held with rural GPs from Western Australia, New South Wales and Victoria. A questionnaire was developed on the basis of the focus group data and all GPs in these three areas were surveyed. Results: The results indicated GPs were more apprehensive about providing after hours care than during business hours. Significant gender differences were found with women being more often apprehensive than men and more likely to withdraw after hours services. Conclusion: This study shows that that levels of apprehension about violence affect GPs’ willingness to provide after hours services. Future provision of general practice after hours services and home visits in rural areas requires the availability of a safe working environment to reduce GPs’ apprehension about workplace violence. What Is Already Known: Overseas research has shown that many GPs are apprehensive about workplace violence and that female GPs are more likely to be apprehensive about it than male GPs. No Australian studies about GPs’ levels of apprehension about workplace violence have previously been undertaken. What this study adds: This study showed that many Australian rural GP respondents feel apprehensive about work‐related violence especially after hours and when undertaking home visits after hours. Female respondents were significantly more likely to feel apprehensive about workplace violence than male respondents and to make changes to services because of the risk of violence than male GPs, most commonly by not providing services such as home visits or after hours surgery attendances.     

Health system frailties in tuberculosis service provision in Russia: an analysis through the lens of formal nutritional support

OBJECTIVE: The aim of this study was to describe health system challenges faced by tuberculosis (TB) treatment facilities in Russia through an analysis of formal institutional dietary provisions to patients in an inpatient facility that provides care for poor patients. METHODS: Analysis of formal dietary provisions by institutions and financing data from TB hospitals in Samara Oblast, Russia. RESULTS: Formal dietary provision for inpatients with TB has fallen substantially in recent years. In a hospital providing inpatient care for the poorest patients with fewest social support networks, this has been very pronounced. The likely reason for this is that financial support for other budget lines, principally salaries, has required protection. CONCLUSION: Formal institutional nutritional support in institutions providing care for the poorest patients with TB is unlikely to be enhancing the speed of recovery, or reducing the duration of infectiousness. Furthermore, the role that hospital may have played in the past in enabling patients to regain weight lost before admission may have been limited by reductions in formal financing. Reductions in state provision of food for patients may serve as an important illustration of wider TB control system frailties in the Russian Federation.     

Adverse effects of social pressure to be thin on young women: an experimental investigation of the effects of "fat talk"

OBJECTIVE: Experiments have found that pressure to be thin from the media promotes body dissatisfaction and negative affect, but the effects of social pressure to be thin have not been examined experimentally. Thus, this study tested whether social pressure to be thin fosters body dissatisfaction and negative affect. METHOD: Young women (N = 120) were randomly assigned to a condition wherein an ultra-thin confederate complained about how fat she felt and voiced intentions to lose weight or a control condition wherein she discussed a neutral topic. RESULTS: Exposure to social pressure to be thin resulted in increased body dissatisfaction but not negative affect. The effects were not moderated by initial thin-ideal internalization, body dissatisfaction, or social support. DISCUSSION: Results support the assertion that peer pressure to be thin promotes body dissatisfaction but suggest that this factor may not contribute to negative affect.     

抗精子抗体与不孕症关系的研究

对２２１对不孕夫妇及１００对孕早期夫妇进行抗精子抗体（ＡｓＡｂ）及解脲支原体（ＵＵ）检测，探讨精浆、宫颈粘液及血清中抗精子抗体和解脲支原体感染对不孕症的作用。结果：不孕男性精浆ＡｓＡｂ阳性率为９．０５％，生育组为２．００％（Ｐ＜０．０５）；不孕女性宫颈粘液ＡｓＡｂ阳性率为１３．５８％，生育组为５．００％（Ｐ＜０．０５）。不孕组男女生殖道ＵＵ阳性率明显高于生育组，差异显著（Ｐ＜０．０５）。精浆ＡｓＡｂ阳性不孕病人１３．４３％存在ＵＵ感染（Ｐ＜０．０５），宫颈粘液ＡｓＡｂ阳性不孕女性病人１８．４４％存在ＵＵ感染（Ｐ＜０．０１）。本文表明：生殖道ＡｓＡｂ的产生与ＵＵ感染有关，两者是引起不孕的原因。     

Gay Male Couples’ Attitudes Toward Using Couples-Based Voluntary HIV Counseling and Testing

Many men who have sex with men acquire HIV from their primary male partners while in a relationship. Studies with gay couples have demonstrated that relationship characteristics and testing behaviors are important to examine for HIV prevention. Recently, couples-based voluntary HIV counseling and testing (CVCT) has become available to male couples throughout the U.S. However, HIV-negative couples’ attitudes toward using CVCT and how their relationship characteristics may affect their use of CVCT remain largely unknown. This information is particularly relevant for organizations that offer CVCT. To assess couples’ attitudes, and associated factors toward using CVCT, a cross-sectional study design was used with a novel Internet-based recruitment method to collect dyadic data from a national sample of 275 HIV-negative gay couples. Multivariate multilevel modeling was used to identify factors associated with differences between and within couples about their attitudes towards using CVCT. Findings revealed that couples were “somewhat” to “very likely” to use CVCT. More positive attitudes toward using CVCT were associated with couples who had higher levels of relationship satisfaction and commitment toward their sexual agreement and among those who had at least one partner having had sex outside of the relationship. Less positive attitude toward using CVCT was associated with couples who had higher levels of trust toward their partners being dependable. Differences within couples, including age between partners, whether sex had occurred outside of the relationship, and value toward a sexual agreement also affected their attitudes toward using CVCT. Providing additional testing methods may help HIV-negative gay couples better manage their HIV risk.     

Qualifying choice: ethical reflection on the scope of prenatal screening

In the near future developments in non-invasive prenatal testing (NIPT) may soon provide couples with the opportunity to test for and diagnose a much broader range of heritable and congenital conditions than has previously been possible. Inevitably, this has prompted much ethical debate on the possible implications of NIPT for providing couples with opportunities for reproductive choice by way of routine prenatal screening. In view of the possibility to test for a significantly broader range of genetic conditions with NIPT, the European Society of Human Genetics (ESHG) and American Society of Human Genetics (ASHG) recommend that, pending further debate, prenatal screening for reproductive choice should only be offered where concerning serious congenital conditions and childhood disorders. In support of this recommendation, the ESHG and ASHG discuss a number of ethical issues on which they prompt further debate: the informational privacy of the future child, the trivialization of abortion, the risk of information overload, and issues of distributive justice. This paper responds to this call with further reflection on each ethical issue and how it relates to the moral justification of providing couples with opportunities for meaningful reproductive choice. The paper concludes that whilst there may be good reasons for qualifying the scope of any unsolicited prenatal screening offer to serious congenital conditions and childhood disorders, if prenatal screening is justified for providing couples with opportunities for meaningful reproductive choice, then health services may have obligations to empower couples with the same opportunity where concerning other conditions.     

Providing a children's palliative care service in the community through fixed-term grants: the staff perspective

BACKGROUND: Children's palliative care services have recently been awarded fixed-term grants, aimed at improving the provision of care for children with life-limiting conditions in the community. We report findings of a qualitative study to investigate the experience of a cohort of community children's nurses from teams involved in setting up or extending community-based children's palliative care services. The purpose of the study was to identify factors that affect service delivery, from the staff perspective, and to suggest ways of promoting their sustainable development. METHODS: Semi-structured telephone interviews were conducted with 21 nurses from 12 different teams providing palliative care for children at home and in hospices. Participants were questioned about the services they provided and their own roles in that provision. NVIVO qualitative data analysis software was used to explore themes arising from the transcribed recorded interviews. FINDINGS: Key findings were the importance of physical location in facilitating multidisciplinary communication, the importance of defining role boundaries between existing and new providers of children's palliative care, and the potentially detrimental impact of insecure funding on referral patterns and recruitment to posts. Staff named the opportunity to offer direct 'hands-on' care to families, access to work-based support and networking opportunities as important factors in helping them cope with the stresses involved in managing finite resources and the emotional challenges of their work. CONCLUSIONS: The maintenance of a mixed caseload with a significant proportion of direct care, provision of ongoing support and clearly defined roles are recommended as means of bolstering the ability of staff to develop their services. The deliberate locating of services to enhance communication between staff and guidance on the preparation of funding applications may further contribute to the sustainability of these services.     

Comparing specialist early years provision for speech and language impaired children with mainstream nursery provision in the UK - an application of the Early Childhood Environment Rating Scale (ECERS)

BACKGROUND: This study examines the application of the Early Childhood Environment Rating Scale (ECERS) to specialist early years provision for children with developmental speech and language impairment. The scale, which has been used in the national Effective Provision of Pre-school Education (EPPE) study in the UK comprises seven subscales describing the quality of provision along a continuum centred on the following areas: 'space and furnishings', 'personal care routines', 'language reasoning', 'activities', 'interaction', 'program structure', and 'parents and staff'. METHODS: The ECERS was applied to two nurseries funded by the UK charity I CAN by two researchers with inter-rater-reliability coefficients ranging from 0.91 to 0.96. RESULTS: There were notable differences between the specialist early years provision and 'average' nursery provision in the UK. On 7/8 measures the early years centre scores are markedly higher than average pre-school provisions. The standard of education and care for the pre-school provisions included in the EPPE project ranged from below minimal (for the diversity subscale, ECERS-E) to approaching good (for the space and furnishings subscale). In contrast, the early years centres were rated as between minimal to good on areas such as space and furnishings and good to excellent on all other areas. CONCLUSIONS: Clearly specialist services such as those described offer something different from the average. Given results which suggest the positive effects on the children's language abilities of such services it is quite possible that the distinctive characteristics of the nursery environment are responsible for the positive impact. There is a good case for extending the application of the ECERS as a way of helping those providing specialist services start to detect the active ingredients of the provision.     

Women's perceptions of support from partners, family members and close friends for smoking cessation during pregnancy--combining quantitative and qualitative findings

This article reports on data collected as part of a four-phase study initiated to strengthen practice in the field of smoking cessation during pregnancy. It focuses on the perceived support pregnant smokers would receive for quitting smoking and how this support could be effectively used by incorporating the education of partners/family in smoking cessation intervention strategies. Both quantitative and qualitative methods were employed, and data were collected from pregnant smokers through semistructured interviews and self-completed questionnaires. From the questionnaire data, the women reported that they would receive considerable support from their partners if they decided to stop smoking. The interviews, however, revealed that this support was 'potential' rather than 'real' and that the partners mostly made 'token gestures' such as smoking outside. None of the interviewed respondents reported receiving help in educating their partner/family about the risks of active and passive smoking, thus reducing the potential positive role they could play in smoking cessation. Whilst health professionals are aware of the important role the partner/family may play in successful smoking cessation interventions, these significant others are generally not involved. This study highlights the need for consideration to be given to providing opportunities for couples to be fully involved in smoking cessation interventions outside the antenatal environment.     

The impacts of marriage,cohabitation and dating relationships on weekly self-reported physical activity in Germany: A 19-year longitudinal study

Despite the increasing number of non-marital romantic relationships in developed countries, little is known about their effects on health-related behaviors. This paper examined the impact of relationship status (single, dating, cohabiting or married) on physical activity. Three possible mechanisms underlying this association were discussed: social control and support by the partner, time restrictions and the release from the marriage market. Data were obtained from the German Socio-Economic Panel (GSOEP), a random sample of individuals living in private households in Germany. Both random-effects and fixed-effects logit models were estimated. The random-effects analyses referred to 30,201 individuals and the fixed-effects analyses referred to 11,568 individuals who were observed for up to 19 years. After adjusting for age, measurement period and the presence of children, fixed-effects estimates showed reduced physical activity for each type of relationship for both men and women. The effects were strongest for married couples and weakest for dating couples, and remained similar after controlling for discretionary time. However, the effects found partly depended on age: for men, the negative impacts of cohabitation and marriage on physical activity became weaker with increasing age and shifted to positive impacts. For women, the negative effect of marriage on physical activity also decreased but stayed negative into old age. The results suggest that the release from the marriage market may cause the negative effects of relationships on physical activity. Social support and social control may play a role in older age, whereas the amount of discretionary time seems to be of minor importance for explaining relationship effects on physical activity. If the results will be validated by other studies there will be valuable implications for health promotion programs.     

云南省人口计生部门出生缺陷一级干预服务的提供和利用研究

目的:通过对出生缺陷一级干预服务的提供和利用状况进行分析,从服务提供的角度,提出改进服务细节的建议。方法:采用定量、定性研究方法,对云南省红河州7个试点县为期3年的降低新生儿出生缺陷率的综合防治技术研究的项目实践,了解目前县、乡两级计划生育服务机构的服务能力和服务水平,育龄夫妇对这些服务的了解程度、利用情况及主要影响因素,收集现场的有关数据。结果:7个县计划生育服务机构具备了开展出生缺陷一级干预的相关工作基础和条件,3年中有超过40%的目标人群接受了所提供的各类服务,其中健康教育率为73.14%,叶酸增补率为41.63%。以全面实施三级干预的1个县为例,2005年6月～2006年12月共计出生婴儿5151人,参加队列研究的4058人,占出生人数的78.78%,项目筛查出了部分有生育出生缺陷儿风险的目标人群,通过积极干预避免不良妊娠结局的发生。结论:通过服务提供者的能力建设,健全技术服务标准和规范,加强咨询,提供优质规范的服务,促进育龄群众对服务的利用。     

Momentary Affective States Surrounding Sexual Intercourse in Depressed Adolescents and Young Adults

Depressed young people may have sexual intercourse (sex) to regulate their disordered affective states. This study sought to determine how momentary positive and negative affect relate to subsequent sex events in depressed adolescents and young adults. Fifty-four outpatients (87% female) 15–22 years who reported clinically significant depressive symptoms and having sex at least once a week completed a baseline survey, then reported momentary affective states and the occurrence of sex events on a handheld computer in response to 4–6 random signals per day for 2 weeks. Participants identified 387 unique sex events (median, 3.5/participant/week) on 3,159 reports (median, signal response rate 80%). Most (86–96%) reported low burden of participation on questions asked at study completion. Similar to what has been reported in non-depressed young people, momentary positive and negative affect were both improved beginning approximately 6 h before until approximately 6 h after a sex event. Positive affect was lower in the 24 h before this pericoital period, compared to other times. Negative affect did not significantly differ between before the pericoital period and other times. The findings suggest that depressed youth may have sex to regulate their positive affect and have implications for provision of their mental and physical health care.     

‘They’re doing surgery on two people’: a meta‐ethnography of the influences on couples’ treatment decision making for prostate cancer

Background Current orthodoxy suggests that patients need to be provided with full information about their care and that treatment options should be discussed with patients and family members. This imperative is especially challenging when there is a lack of consensus about treatment effectiveness and equivocacy over different types of interventions. In the case of prostate cancer, evidence is contested as to the efficacy of different treatments. Thus, involving patients and their family members in treatment choices is complex and little is known about how patients and their partners process these decisions when there is uncertainty about different outcomes. This paper has reviewed the literature on the way couples approach such decision making in relation to treatment for prostate cancer. Objective A meta‐ethnographic synthesis of published qualitative papers that focused on the influences on patients’, and their partners’ treatment decision making for prostate cancer, was conducted in order to identify and understand barriers and facilitators which impact on this process. Results Our synthesis indicates that the couples’ relationship ‘dynamic’ provides a contextual background against which treatment decisions are negotiated and made. Discussion and conclusions We propose that the findings from this synthesis can enhance the potential for shared decision making for patients, and their partners, when facing a treatment decision for prostate cancer. By understanding the couples’ relationship dynamic pre‐diagnosis, clinicians may be able to tailor the communication and information provision to both patients and their partners, providing a personalized approach to treatment decision making.     

It Takes Two to Talk--The Hanen Program and families of children with motor disorders: a UK perspective

BACKGROUND: Speech and language therapy for young children who have motor disorders targets both the children themselves and their parents. Therapy for parents often involves training about communication and how to foster children's development. It Takes Two to Talk--The Hanen Program for Parents has become popular in the UK, but has not been specifically evaluated for this client group. This study, which was part of a larger investigation of the acceptability and potential effects of the programme on the communication patterns of mothers and their young children with motor disorders, investigated therapists' experiences of providing the training in the National Health Service (NHS) and their views on its effectiveness. METHODS: Four focus groups, which involved 16 speech and language therapists who provide It Takes Two to Talk in NHS Trusts in England, were analysed using qualitative methods. RESULTS: The themes indicated that therapists perceived the training programme to be effective in helping parents to develop a facilitative communication style. Therapists reported secondary outcomes of positive changes in parents' confidence and in relationships between parents and their children and between parents and therapists. Barriers to the provision and success of the programme were thought to relate to resources, parents' apprehensions about the programme's content and delivery and support from key stakeholders. Barriers were seen to be minimized in services where other members of the healthcare teams actively supported the training programme and where the intervention was integrated as part of a care pathway. CONCLUSIONS: The information from this study may assist service providers in the marketing, planning and delivery of new intervention methods, to ensure that they are seen as valuable and acceptable by parents.     

Working With What We've Got: Perceptions of Barriers and Supports Among Small-Metropolitan Same-Sex Adopting Couples

In seeking to adopt, lesbians and gay men may confront various barriers and obstacles. Ideally they have access to a variety of support resources that can help to buffer the negative effects of these barriers. However, lesbians and gay men living in small-metropolitan communities may have limited access to support resources. The current qualitative study examined the perceptions of 37 same-sex couples who were pursuing adoption while living outside of large metropolitan cities, with attention to the barriers these couples encountered during the adoption process, and the resources they drew upon to cope with such challenges. Findings indicated that same sex couples living in small-metropolitan areas confronted several major barriers in the adoption process, such as a lack of geographically accessible gay-friendly adoption agencies. Despite limited access to support, participants showed evidence of notable resourcefulness. For example, participants with limited access to formal support groups sought out informal supports instead.     

Correlates of partner support to abstain from prenatal alcohol use: a cross‐sectional survey among Dutch partners of pregnant women

Partners can play an important role, but are often ignored in interventions targeting the prevention of prenatal alcohol use. A better understanding of the correlates of partner support to abstain from prenatal alcohol use can help to make a better use of partner support. The aim of this study was to identify correlates of this support by analysing differences between partners reporting low versus high support. An online cross‐sectional study among 237 Dutch partners of pregnant women was conducted. Respondents were recruited through Dutch midwifery practices in September–October 2009. Questionnaires were based on the I‐Change Model. Chi‐square and t‐test showed that partners reporting high support were more likely to desire their partner to abstain from alcohol use and to have received advice from their pregnant spouse or midwife that abstinence was desirable. They also had stronger perceptions that the baby would experience harm from prenatal alcohol use and that harm could be more severe, and they saw more advantages and fewer disadvantages of providing support. They also reported more influence from their social environment encouraging their support, had greater self‐efficacy and had a stronger intention to support their partner during the remainder of the pregnancy compared to partners reporting low support. Health professionals may improve their alcohol advice by discussing the advantages and disadvantages of support with the partner and by encouraging couples to discuss and propose solutions for the situations in which partners find it difficult not to support alcohol abstinence. By providing an insight into important correlates of partner support, this study expands the research area aiming to reduce prenatal alcohol use.