Sibling psychological adjustment to type 1 diabetes mellitus

Objective:  Type 1 diabetes mellitus (T1DM) is a chronic condition whose management affects the whole family, and siblings of children with chronic conditions have been shown to be at higher risk of emotional and behavioural problems. The aims of this study were to investigate sibling adjustment to T1DM using a cross-sectional questionnaire survey design.
Methods:  Forty-one families (48% of those eligible) were recruited from a children's diabetes clinic. From each family, one parent and one sibling of the child with T1DM participated. Parents completed questionnaires measuring sibling adjustment and measures of major life events, social support and parenting stress. Demographic and disease information was obtained from medical records. Siblings completed questionnaires assessing cognitive appraisals and coping strategies. A semi-structured interview was also administered to siblings.
Results:  Siblings were found to be better adjusted than normative data (p < 0.01). Factors associated with poorer sibling adjustment were higher sibling age at diagnosis, higher levels of parenting stress, more difficult sibling temperament, poorer adjustment of the child with T1DM, higher levels of parental distress and more negative sibling perceptions of diabetes and its impact on the family. Results suggest that sibling perceptions of diabetes and parental distress are important predictors of sibling adjustment to T1DM.
Conclusions:  The findings from this study emphasize the relationships between the adjustment of the sibling and that of the child with T1DM and their parents. Many parents worry about how the siblings may cope with the diabetes, but the results of this study are generally reassuring.     

Psychosocial adjustment patterns of persons with spinal cord injury in Taiwan

Purpose. The purpose of this study was to examine the psychosocial adjustment patterns of a community sample of persons with spinal cord injury in Taiwan.

Method. A total of 102 participants were recruited from the Association of People with Spinal Cord Injury in Taipei City. Mean age of participants was 30.8 years (SD = 11.39 years), and 77% were men. The participants were asked to complete a research packet containing a demographic questionnaire, the Psychosocial Adjustment to Illness Scale-Self Report Questionnaire, and the Sense of Coherence Questionnaire.

Results. Four distinct groups were found, representing different levels of psychosocial adjustment: (i) Well adjusted, (ii) Moderately adjusted, (iii) Moderately adjusted and sexually inexperienced, and (iv) Poorly adjusted. Employment status, age at the time of onset, injury level, and current age, as well as the motivational and behavioural aspects of coping, were identified as the functions discriminating the groups based on the demographic characteristics and sense of coherence, respectively.

Conclusions. Vocational, sexual, and leisure areas of adjustment were found to be the most problematic for individuals with SCI in Taiwan. Counseling and other rehabilitation intervention efforts should focus on these identified needs of people with SCI in Taiwan.     

Reformulating masculinity: Traumatic brain injury and the gendered nature of care and domestic roles

Purpose.?This article examines the nexus between masculine identity and participation of men living with traumatic brain injury (TBI) in rural New South Wales, Australia. The article considers the impact of adoption of caring and household duties upon identity and participation satisfaction.

Method.?The focus of this paper is on a finding that emerged from the qualitative phase of a larger project examining participation following TBI in rural and regional areas. During semi-structured interviews, participants were invited to discuss aspects of their participation including their daily occupations, supports, experience of country life and rehabilitation services. A grounded theory methodology shaped the analysis of the interviews.

Results.?Results, relating to the reformation of masculinity, centred upon eight men drawn from the cohort who moved from the role of breadwinner pre-injury to primarily domestic and caring roles post-injury. Their narratives illustrated three responses to altered life circumstances that necessitated the revision of gendered roles: non-acceptance of reformulated masculinity, accepting reformulated masculinity for the sake of others and accepting and personally valuing a reformulated masculinity.

Conclusions.?Participation satisfaction for men who take up responsibility for domestic and/or caring duties following TBI is contingent upon successful reformulation of their gendered identity. The research highlights the need for rehabilitation practitioners to adequately support psychosocial adjustment for men following TBI.     

Parental adjustment to the completion of their child's cancer treatment

Childhood cancer treatment completion is a significant milestone. However, coming off treatment may be a time of psychological vulnerability for parents. This review assesses published research (1979-2009) on the psychosocial impact of treatment completion on parents. Fifteen articles met all inclusion criteria and demonstrated that while they celebrate treatment completion, parents (particularly mothers) can experience significant distress, including fear of recurrence, fatigue, and loneliness. Distress appears to ease with time, possibly as the perceived risk of relapse declines. Continued psychosocial support specifically targeting parents' risk perceptions, physical and emotional fatigue, social isolation, and parenting concerns post-treatment is warranted.     

Labor adjustment in the Japanese health care industry: some empirical evidence

This paper examines the labor adjustment costs in the health care industry. Using Japanese data, we find that the cost of hiring new health care workers is the largest component of labor adjustment costs in the health care industry. Hence, it is difficult for employers in this industry to immediately increase the number of workers since this employment adjustment is extremely expensive.     

Daily welcoming in childcare centre as a microtransition: an exploratory study

This study focuses on the everyday morning microtransition in childcare centres that involves child–parent separation. This moment involves the contemporary presence of the child, caregiver and parent in the day-care centre. This coexistence is considered extremely relevant and full of important meanings for the interactive patterns they will build together and for the children's development. In order to explore this topic, 4 children (mean age 26 months), their parents and 3 caregivers were observed in a day-care centre for 3 months, for a total of 20 video-observations. Using a triadic perspective and microanalytic analysis method, the observations were analysed through the application of the triadic interaction analytical procedure. The results showed different interactive sequence processes to the microtransition from the parent–child interaction to the child–caregiver interaction. However, various types of interactive patterns emerged in relation to the child–parent–caregiver interaction, which show the active role of all the members in the co-construction of the interactive dynamic.     

公立医院的资源配置与结构调整

公立医院的资源配置和调整首先要根据社会经济的变化进行修订和完善，并建立动态的调控机制。目前，公立医疗资源的存量不仅应该基本稳定，而且应该有所发展，才能体现其主体地位。政府办的二、三级医院是现有资源存量中的优质资源，要适度发展，以满足群众多层次多样化的健康需求。由于城乡二元社会经济结构所造成城乡公立医疗资源配置不合理的状况，通过整合提高资源利用效率，同时要切实加大对农村卫生的投入，加强城乡社区卫生机构建设。改革公立医院办医主体实现形式，鼓励社会和民间资本参与公立医院建设。公立医院要重视院内资源管理，实现人尽其才，物尽其用。