Boundary Ambiguity in Parents With Chronically Ill Children: Integrating Theory and Research

Abstract: This article integrates theory and research related to boundary ambiguity in parents of children with a chronic health condition. We propose that boundary ambiguity is a risk factor for psychological distress in these parents. Clinical applications and a case example highlight how boundary ambiguity can be assessed and managed in clinical settings by professionals working with parents with chronically ill children. Questions are provided for assessing boundary ambiguity in clinical and research settings, and implications for research are discussed.     

北京市宣武区中学生生殖健康知识调查分析

【目的】掌握青少年性发育特点,以便开展有针对性的青春期生殖健康教育,提高自我保护能力,使其健康的成长。【方法】重点高中2所、普通高中4所、职业高中3所,分别选择同年级、同号班级22个班的1 800名高中生,由专门调查员进班发问卷,要求学生在15 min内完成。学生填写问卷时,采用校方人员回避,问卷不记名方式,填写后当场封存,确保学生的隐私权。【结果】调查学生中生理知识知晓率达到70.74%,性病、艾滋病方面知识知晓率达53.9%,相关避孕知识知晓率15%,学生中的性活动发生率17.9%,缺乏保护意识的学生占25.4%,接触过淫秽品的学生43.5%,对婚前性行为的看法持开放态度的学生占38%。【结论】学生的性观念开放,综合自我保护能力较低,易受疾病和社会危险因素伤害,对其成长过程造成障碍。     

Controlling for occasion-specific effects when assessing the test–retest reliability of self-report health questionnaires

OBJECTIVE: This study proposes a method for self-report health questionnaires to adjust test-retest reliability for changes during the test-retest interval based on an external measure, and to distinguish such changes from random response errors. METHODS: In our application, eighty participants completed the Symptoms of Illness Checklist (SIC) on two occasions, two weeks apart, immediately before interviews given on each occasion by one of two physicians in a crossover design. The physician interview scores served as external measures, and structural equation modeling was used to estimate the parameters of a model that corrected for the occasion-specific effect of participants' responses using information from the interviews. RESULTS: Correcting for changes in symptoms during the test-retest interval increased SIC test-retest reliability from .744 to .804 and significantly improved model fit (chi2(diff)(1) = 30.78, p < .001). CONCLUSIONS: The results suggest methods that can improve the evaluation of self-report health questionnaire test-retest reliability by identifying changes using an external measure, and distinguishing these from random response errors; these increased the estimated SIC test-retest reliability and indicated that the SIC was indeed able to measure changes over the studied time interval. This method can be applied across a broad range of questionnaires.     

Reproductive health knowledge and implications: A study in Nigeria

Forty-five percent of Nigeria's population is under age 15. This study employed a questionnaire to learn the level of reproductive health knowledge of 416 male and female Nigerian students ages 10 through 16.

The Chi-square statistical procedure was used as demographic characteristics were related to reproductive health knowledge among the pre-teen and teenage youth. Statistically significant (p #lt 0.05) relationships were found between variables such as knowledge of reproduction, family planning, and AIDS when each was compared separately to age, gender, living situation while at school, school club memberships, and so on. With respect to reproduction and related topics, older teenagers indicated more knowledge than pre-teenagers, girls more than boys, and those living in dormitories more than those living at home or in other housing while attending school.

Television ranked first in terms of students' sources of information on reproduction, pregnancy, birth control, and AIDS. Newspapers ranked second, radio third, teachers fourth, and parents fifth. Perhaps the most striking data are the “I don't know” responses with respect to AIDS. Thirteen percent had not heard of AIDS, 27 percent did not know how AIDS is transmitted, 29 percent did not know the seriousness of AIDS, 37 percent did not know how to avoid AIDS, and 14 percent did not know that a mother with AIDS might infect her baby. Recommendations are made for increasing health services and education concerning reproductive health for pre-teen and teenage students.     

微波与X线联合辐射对人体血液系统的影响

本文调查了微波与X线同时接触工人49名(联合组)、单微波接触工人48名(微波组)以及两者均不接触的工人46名(对照组)。联合组和微波组工人的微波辐射剂量每日平均约300μw/cm~2,联合组工人接触的X线剂量,每年小于5rem。结果显示:联合组中性粒细胞ACP、AKP活性以及中性粒细胞核棘突出现率均较微波组和对照组明显增高(P<0.01),糖原含量则较其它两组明显下降(P<0.01)。调查表明,低强度微波与低剂量X线联合辐射比单独微波辐射对人体的潜在危害更大。因此,对雷达等发射设备周围的工作人员,除必要的微波防护外。同时需要对X线进行防护。     

The Mental Health of Homeless Children

The literature addressing the mental health of homeless children is critically reviewed. Higher rates of behavioral, emotional, and cognitive problems have been reported for this population, but research results are qualified by significant methodological problems. Minimal attention has been given to the development and evaluation of specific intervention and prevention strategies. Recommendations are made for conducting research that will overcome previous methodological problems and focus more directly on identifying risk and protective mechanisms within the population of children exposed to homelessness.     

Predictors of mortality in an aging community-based cohort in Korea

Background: Multiple factors related to specific dimensions of health – general, physical and mental – contribute to mortality in the elderly, but their relative contributions to mortality risk is not well‐known. The objectives of this prospective population‐based cohort study were to measure mortality rates and to identify predictors of mortality in community‐dwelling men and women aged 65 years or older in Korea by examining self assessments of general health, objective medical burden, and measurement of cognition, mood and function. Methods: A total of 1245 elderly (529 men; 716 women) were followed up longitudinally for 3.5 years. Fixed predictor variables observed at baseline examined in Cox proportional hazards models were age, sex, education, chronic medical illnesses, self‐rated health, basic activities of daily living, depression measured by the Geriatric Depression Scale, and cognition measured by the Mini‐Mental State Examination. Results: Mortality rates were similar to those of the 2001 Korean population. Older age, male sex, poor self‐rated health and presence of cerebrovascular disease were significant predictors of mortality. Presence of ischemic heart disease and cerebrovascular disease at baseline predicted mortality in men, but not in women. Depression predicted mortality only when chronic medical illnesses were excluded from the model. Conclusions: Subjective self‐rated health and objective medical burden are strong independent predictors of mortality in this elderly community population, in addition to age and sex.     

Health and illness behavior and patient-practitioner relationships

Health is a product of culture and social structure. The routine organization and constraints of everyday settings shape our health. Socio-economic status is of major importance in determining exposure to disease risk and in shaping health and illness behavior responses. Lay explanations of illness affect illness appraisal, self-treatment, decisions to seek care and changes in daily regimen. Somatization of psychosocial stressors is a common concern in primary care systems throughout the world, and doctors are commonly frustrated by such patients. Somatizing patients are often enmeshed in environments of great psychosocial difficulty or are depressed, and many cultural and social factors affect how depression is expressed. Although depression has devastating disabling effects on patients, it is often neither recognized by doctors nor treated. But doctor-patient relationships are often the context for appropriate management of such problems, and how they are handled affect the future trajectory of illness and disability. Doctors' responses are conditioned by their attitudes, training, interviewing and psychosocial skills, and organizational and financial factors. Patient flow is an important intervening variable affecting the management of psychosocial difficulties and depression.     

SCL-25 and recognition of mental disorders reported by primary health care physicians

A marked proportion of primary care patients have mental disorders and problems that remain unrecognized by the patients and their general practitioners. There is furthermore a great variation in the physicians’ ability to detect mental disorders. The aim of the present study was to find out the overall prevalence of mental disorders among patients receiving primary health care. The material consisted of 1000 randomly selected adult patients attending primary care facilities in Turku. The mental disorders were assessed by using the Symptom Checklist (SCL-25) and by general practitioners. According to the SCL-25, one fourth of the sample had a mental disorder. Only two fifths of them could be identified by the general practitioners.     

The public's problem with public health research

Public health research is divided into factions which are oftenengaged in bitter theoretical and methodological disputes, especiallywhen issues of funding are discussed. From the perspective ofa user of health services, these rivalries are an obstacle topublic health. This paper explores three approaches to understandingthe foundations of these differences. The first is a discussionof disciplinary sub-cultures, the second a brief discussionof a philosophy of knowledge and the third a social perspectiveon paradigms. The unifying theme is the idea of disciplinarysub-cultures.