Parenting children with neurodevelopmental disorders and/or behaviour problems

Background Parenting behaviours influence child well‐being and development. However, much of the research on parenting behaviours and their correlates has focused on caregivers of healthy, typically developing children. Relatively less is known about the parenting behaviours of caregivers of children with chronic health conditions. Objective To examine and compare three parenting behaviours (positive interactions, consistency and ineffective parenting) among caregivers of children with neurodevelopmental disorders and/or externalizing behaviour problems, before and after accounting for child and family socio‐demographic characteristics. Methods Participants (n= 14 226) were drawn from the National Longitudinal Survey of Children and Youth, a long‐term study of Canadian children that follows their development and well‐being from birth to early adulthood. Children (and their caregivers) were divided into four groups according to the presence of a neurodevelopmental disorder (NDD; n= 815), the presence of an externalizing behaviour problem (EBP; n= 1322), the presence of both conditions (BOTH; n= 452) or neither of these conditions (NEITHER; n= 11 376). Results Caregivers of children in the NEITHER group reported significantly higher positive interaction scores and lower ineffective parenting behaviours than caregivers of children in any of the other three groups. Caregivers of children in the EBP and BOTH groups reported similar levels of consistency, but significantly lower levels than caregivers of NDD or NEITHER children. These associations largely remained after accounting for child and family socio‐demographic characteristics, with two exceptions: caregivers' reports of positive interactions were no longer significantly associated with child's NDD and BOTH conditions. Conclusions Parenting children with multiple health conditions can be associated with less positive, less consistent and more ineffective parenting behaviours. Understanding the factors that are associated with the challenges of caring for these children may require additional research attention.     

The ‘healthy brothel’: The context of clinical services for sex workers in Hillbrow,South Africa

Conventional health services often present barriers to sex workers seeking health care resulting in untreated sexually transmitted infections (STI) and increased risk of HIV infection. A brothel‐based clinic was established to provide STI treatment for sex workers who worked in the inner city suburb of Hillbrow, South Africa. Qualitative research demonstrated that the clinic was acceptable to women in terms of service quality, accessibility, and efficacy, and positively influenced health‐seeking behaviours, health awareness, and condom use. The intervention also transformed the image of the hotels from sites of ‘dirt and disease’ into ‘healthy brothels’. The paper concludes that clinical services offered on site are a viable alternative to the provision of conventional clinical services.

Résumé

Les travailleuses du sexe en recherche de soins sont souvent confrontées à certains obstacles dans les services de soins conventionnels. Il en résulte des infections sexuellement transmissibles (IST) non traitées et une augmentation des risques de contamination par le VIH. Un centre de soins a été installé dans un bordel de la banlieue déshéritée de Hillbrow en Afrique du Sud, pour dispenser des traitements des IST aux travailleuses du sexe exerçant localement. Une étude qualitative a démontré que ce centre était acceptable aux yeux de ces femmes, en termes de qualité des services, d'accessibilité et d'efficacité, et qu'il influait positivement sur les comportements de recherche de soins, la sensibilisation à la santé et l'usage du préservatif. L'intervention a aussi transformé l'image de ces lieux «sales et remplis de maladies» en celle de «bordels sains». L'article conclut que les services de soins sur sites sont une alternative viable aux services de soins conventionnels.

Resumen

Los servicios tradicionales de la salud muchas veces ponen trabas a las trabajadoras sexuales que piden ayuda médica lo que implica que no se traten las infecciones de transmisión sexual y aumente el riesgo de infección del VIH. En un centro de un suburbio de la ciudad de Hillbrow, en Sudáfrica, se creó una clínica dentro de un burdel para ofrecer tratamiento contra las enfermedades de transmisión sexual a las trabajadoras sexuales. En un estudio cualitativo se demostró que la clínica era aceptable para las mujeres en lo referente a calidad de servicios, accesibilidad y eficacia y además influenciaba positivamente en actitudes tales como pedir ayuda médica, interesarse por la salud y usar preservativos. Esta intervención también transformó la imagen de los hoteles que pasaron de ser sitios “sucios y con riesgo de enfermedades” a “burdeles sanos”. Terminamos el artículo defendiendo que los servicios clínicos ofrecidos en estos lugares son una alternativa viable a los servicios clínicos convencionales.     

Socio-cultural influences on the transmission of HIV among gay men in rural China

Bisexual behaviours are relatively common among men who have sex with men in China. This pilot study aims to reveal the complex processes through which such men manage their sexuality, family responsibilities and sexual behaviours in a rural Chinese setting. A total of 15 men who have sex with men were recruited by purposive sampling. Face-to-face in-depth interviews were conducted to explore participants’ views about their sexual experiences and practices. The Chinese traditional moral code, family values and gender roles that form the crucial components of Confucianism were reflected in the participants’ efforts to maintain familial and social harmony through a compromised form of sexual partnership. Most study participants demonstrated a mixed experience of social stigma, sexual naiveté and ignorance of HIV and sexually transmitted infections (STIs). Under cultural and family pressure, men who have sex with men entered heterosexual marriages with the intention of maintaining a balance between their collectivist (familial) obligations and their individualistic (same-sex sexual) desires. However, the opaque nature of their concurrent sexual relationships may endanger their personal health and accelerate HIV and STI transmission. Reducing the stigma and social prejudice associated with male same-sex sexual relations is essential for any culturally sensitive HIV-prevention programme to succeed in rural China.     

Participation and Citizenship of Elderly Persons

Abstract

In the article the participation of the aged users and their relatives in a local health care and social service system will be discussed. How is their citizenship defined at the grass roots level? The research data were gathered during a case management project of the action research type in a Finnish rural municipality. The data of this study consist of 13 theme interviews: five elderly persons as care receivers and eight caregivers. The research approach is a dialogue between data based analysis and conceptual reasoning.

Citizenship rights and obligations and participation should be defined flexibly and individually in the context of the local health care and social services. In the research data the elderly persons and their caregivers described participation in multiple ways. The modes of participation vary from passive and active disengagement from the process to contacting, negotiating, cooperating, and demanding     

Lifestyle patterns concerning sports and physical activity,and perceptions of health

SummaryObjectives To explore the perceptions of health and physical activity, and the associations between these two areas from a theoretical lifestyle perspective.Methods Data was collected by means of a self-administered questionnaire, among 3019 adults attending centres for preventive medicine in France. Correspondence analysis examined the significance of the relationships between perceptions of health and perceptions of sports and physical activity.Results Four pricipal types of subjects emerged from the factor analyses expressing four different lifestyle patterns. Non physically active lifestyle: a feeling of not being healthy, Physically active lifestyle, pleasure/leisure-oriented, Necessarily physically active lifestyle, regardless of health, Physically active lifestyle aimed at stress relief.Conclusions The sociological approach helps tackle sports and physical activity as behaviour patterns but also and especially as a health orientation connected with the socio-economical climate. This approach also gives sports practice back its meaningful cultural dimension.

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ZusammenfassungFragestellung Wie werden Gesundheit und körperliche Aktivitäten und Sport wahrgenommen? Welche Zusammenhänge bestehen zwischen den beiden Parametern in Hinblick auf den Lebensstil?Methoden Die Rohdaten wurden mit Hilfe eines selbst zu beantwortenden Fragebogens gesammelt. Die 3019 Studienteilnehmer sind ausschliesslich Erwachsene, die in einem französischen Vorsorgezentrum während einer freiwilligen Beratungsstunde angesprochen wurden. Der Schwerpunkt der anschliessenden Faktorenanalyse lag in der Suche nach Korrelationen zwischen der Wahrnehmung der Gesundheit und den Eindrücken, die die sportlichen Aktivitäten hinterliessen.Ergebnisse Diese Analyse ermöglicht es, vier Antwortprofile herauszuarbeiten, die letztlich vier verschiedenen Lebensstilen entsprechen: inaktiv, allgemeines Unwohlsein, das sich im klinischen Bereich niederschlägt, aktiv, auf Lustempfindungen orientiert, passiv, fatalistisch, ohne Interesse an Gesundheit, aber gesellschaftsorientiert, aktiv, gesundheitsbewusst, auf Stressabbau orientier.Schlussfolgerungen Aus soziologischer Sicht kann somit die Ausübung körperlicher Aktivitäten einerseits als reines Verhaltensmuster gedeutet werden, andererseits aber auch als gesundheitsorientierte Handlung, eng verknüpft mit den sozioökonomischen Verhältnissen. Sprot an sich erhält somit seine Bedeutung als kulturelle Dimension wieder.

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RésuméObjectifs Etudier les perceptions de la santé et de l'activité physique et sportive, ainsi que les relations entre les deux dans la perspective théorique du style de vie.Méthodes Des données ont été recueillies par questionnaire auto-administré auprès de 3019 adultes consultant un centre de médecine préventive français. Une analyse factorielle des correspondances a permis d'étudier les relations d'affinités entre les perceptions de la santé et celles de l'activité physique et sportive.Résultats Quatre profils de réponses se distinguent par cette analyse factorielle qui font émerger quatre styles de vie: physiquement inactif, le sentiment de ne pas être en bonne santé, physiquement actif, orienté vers le plaisir et les loisirs, physiquement actif au travail sans attention pour la santé et physiquement actif pour lutter contre le stress.Conclusions L'approche sociologique permet d'aborder la pratique physique et sportive, comme un comportement mais aussi et surtout comme une orientation de santé, en relation avec les conditions socio-économiques. Elle redonne ainsi à la pratique sportive sa dimension culturelle signifiante.

     

Hostility and the educational gradient in health. The mediating role of health-related behaviours

BACKGROUND: The aim was to study hostility as a factor intermediate in the association between educational level and health. METHODS: 1997 cross-sectional data from the Dutch GLOBE study (1675 men and 1819 women) was used. The analyses distinguishes between direct effects of hostility on health, and indirect effects, which are through health-related behaviours. The latter indicates that hostile people may be at risk of adverse health, because they engage in unhealthy behaviours. Data were analysed with logistic regression techniques. RESULTS: Among men and women, the odds of less than good health was higher in lower educational groups. A substantial part of the educational gradient in health could be ascribed to the intermediate effects of hostility. Among both men and women, the direct effects of hostility were more important than indirect effects. CONCLUSION: Results suggest that interventions should be aimed at the prevention of the development of hostility. Additionally, interventions aimed at the reduction of health damaging behaviours among adults may lead to a reduction of socio-economic inequalities in health.     

Mental disorders and problematic behaviours in people with intellectual disability: future directions for research

In recent years there has been a nriajor growth of interest in the field of mental health and intellectual disability. This article outlines some of the issues that will be important to address in the coming years. The issues discussed include: the interaction of biological and environmental factors in the aetiology of behavioural and psychiatric disorders; diagnosis and classification; epidemiology; dementia; recognition of mental illness in the community; treatment; service provision; and training.     

EFFECTS OF LIFESTYLE, COPING AND WORK-RELATED STRESS ON BLOOD PRESSURE IN OFFICE WORKERS

1. The relative importance of perceived stress compared with coping behaviours and ‘lifestyle’ characteristics known to influence blood pressure were studied in 337 male and 317 female office workers. 2. Males had significantly higher mean systolic (P<0.01; t-test, 652 d.f.) and diastolic (P<0.01; t-test, 652 d.f.) blood pressure and unhealthier lifestyles than females, particularly in the areas of alcohol intake (P<0.01; t-test, 653 d.f.) and diet (P= 0.01; t-test, 663 d.f.). 3. In males drinking alcohol was correlated to job and home/work stress (P<0.05), and eating more atherogenic foods was correlated to home/work stress (P<0.05). 4. Coping by food and drug consumption was correlated with job and home/work stress (P <0.05) in males; avoidance/ denial coping was correlated with job stress in both males and females (P<0.001) and to home/work stress (P<0.001) in males only. Blood pressure was not correlated with stress in males or females. 5. In age-adjusted regression analyses body mass index (BMI) and lifestyle (physical inactivity, alcohol consumption and diet) made significant contributions to systolic (P= 0.02) and diastolic (P<0.01) blood pressure and, in separate analyses, coping contributed significantly to diastolic blood pressure (P<0.01) in males. Stress made no additional contribution to blood pressure in either analysis. 6. After including age, BMI, lifestyle and coping in males ‘lifestyle’ still contributed to systolic and diastolic blood pressure and coping made a significant additional contribution to diastolic blood pressure. Neither lifestyle or coping contributed significantly to blood pressure in females. 7. Thus obesity, alcohol, physical activity and diet had dominant effects on blood pressure; while any effects of job stress were indirect and related to maladaptive coping, particularly in males.     

Social environment and health behaviour: a case study of Japanese overseas students

The health related problems and issues of overseas studentsstudying in Australia were addressed within the social perspectiveof health and health behaviours. It was argued that a clinical‘one-to-one’ approach to treating somantic illnesswithin the biomedical model and modifying health behavioursthrough traditional health education approaches, failed to bringabout comprehensive changes in health outcomes. Instead, a modelwhich addresses the social perspective of health behaviour andsocial environmental strategies was proposed as a more effectivemeans by which to bring about changes. A case study of 28 Japanesestudents studying English-as-a-Second-Language (ESL) at an Australianrural tertiary education institution is presented to illustratethe effects which the physical and socio-cultural environmentshave upon the health behaviours of a culturally sensitive andisolated population. Factors which were found to influence thehealth status and health habits of Japanese students were thoserelated to community structure and its competencies, socialinteraction, diet, traditional Japanese healing practices andconceptualization of illness within Japanese culture. Thesefactors inadvertently interacted with the Australian physicaland socio-cultural environment resulting in health problems.It was proposed that primary health care policy-based strategies,focusing on the Japanese and Australian socio-environmentalas well as socio-physiological aspects of health, leading toreorientation, would be more successful in inducing change.     

The construction of meaning by experts and would-be parents in assisted reproductive technology

This article explores the construction of meaning regarding assisted reproductive technology by legal framers, medical practitioners and would-be parents, through the concept of ecology of knowledge. It is argued that these inter-relationships between experts and lay people can be understood in terms of the formation of a social structure of ecology of knowledge, which depends on local and emotional knowledge co-produced by medical doctors, jurists and lay people in dynamic ways without compromising the autonomy of medical, legal and lay knowledge and skills. The assessment of the benefits and risks of assisted reproductive technology partially represents negotiations of knowledge between these social and professional groups, aiming to reproduce existing relations and practices, particularly the social power of medicine and technology, the dominant perceptions about women's and men's bodies and the geneticisation of genealogy. These negotiations of knowledge generate new rights, new social actors, new scientific fields and new ways of thinking and talking about individual and institutional responsibilities. Ecology of knowledge comes imbued with hope, trust, power, credibility of institutions and moralisation whereby some citizens' rights may be weakened.