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PubMed1986

Cultural components of behavioural epidemiology: implications for primary health care.

In this article we discuss the association of culturally linked behaviour and epidemiology: that patterns of disease are significantly related to cultural sets of normative beliefs and behaviour. The literature on this is vast and includes much of what is written under the headings of Medical Anthropology as well as, for example, Cross-cultural Psychiatry and Medical Geography. A comprehensive review is obviously impossible, but as this is presented primarily as a background paper, basic issues are raised, and related to examples from the literature, to stimulate discussion. The article is divided into four subsections which give an indication of our focus: culture, disease and illness causation; utilization and provision of health resources; health, illness and normative socio-political and economic behaviour and primary health care, community participation and culture--implications for the future.

Behavioral Sciences↗

PubMed2005

Provision of HIV treatment in HIV preventive vaccine trials: a developing country perspective.

HIV treatment for participants who become infected during HIV vaccine trials has been the focus of ethical controversy. The obligations of sponsors to ensure that participants have access to antiretrovirals have been a particular focus of this debate. This paper presents three arguments that have been made in this regard, and some of their limitations, in anticipation of HIV vaccine trials in South Africa. The first argument is that HIV risk behaviour increases in such trials, and HIV infection can be viewed as a research-related injury, justifying sponsor provision of treatment on grounds of compensation for harm. We conclude that risk-behaviour studies to date do not show general increases in risk behaviour that could constitute the basis for a general obligation. Participation may well adversely impact on risk behaviour for some individuals, and conceivably this could be demonstrated. This argument may, therefore, have merit at the individual level; however, it seems a weak platform from which to argue that sponsors should treat all HIV infections acquired during trials. The second argument is that treatment should be provided based on distributive justice. We conclude that traditional concepts of "distributive justice" in research appear limited in justifying obligations of sponsors to ensure access to antiretrovirals. Further, using research initiatives to reduce global health care inequities is controversial, and even proponents may disagree about the fairest use of finite resources. The third argument is that sponsors should ensure antiretroviral access on grounds of beneficence; namely, the maxim that if one can do something beneficial without sacrificing anything of comparable significance, it ought to be done. Thus, sponsors should provide more interventions than those minimally required to conduct the research. However, beneficence may demand levels of altruism that exceeds what is reasonable. While the latter arguments may provide stronger justifications than the first, it is difficult to use these arguments to establish that sponsor provision of antiretrovirals to infected individuals is obligatory.

AIDS Vaccines↗

PubMed1987

Making access to health care more equal: the role of general medical services.

The Resource Allocation Working Party (RAWP) recognised the need to consider both health authority and primary care services in achieving its objective. RAWP and the subsequent Advisory Group on Resource Allocation (AGRA) found (but did not publish) considerable variation in resources used by both services but could not find a clear relation between them. Statistics provided by the DHSS were used to compare spending by 80 area health authorities in 1980-1 with expenditure per head on general medical services by their corresponding family practitioner committees. There was considerable variation in the provision of resources for both services and no clear relation between the variations in spending on each service. Only 40 of the 80 areas had both health authority and family practitioner committee spending levels within 10% of "target." Subregional inequalities in resources tend to be related to variations in admission rates, which in turn are related to general practitioners' referral behaviour. These results emphasise the importance of finding out more about inequalities in the provision of general medical services and their relation to the use of hospital services. They also suggest that RAWP's aim of equality of opportunity of access to health care resources may be achieved only if general medical services are brought into the equation as well.

Family Practice↗

PubMed2006

Maternal food provisioning in relation to condition-dependent offspring odours in burrower bugs (Sehirus cinctus).

The sensory modalities used for communication among family members have at least partly evolved within an organism's pre-existing sensory context. Given the well-known general importance of chemical communication in insects, we hypothesized in sub-social insects with parental care that chemical signals emitted by larvae to influence parental care (i.e. solicitation pheromones) would have evolved. To test this hypothesis, we performed an experiment in the burrower bug Sehirus cinctus (Hemiptera: Cydnidae) where nymphs were hand-reared under high- or low-food conditions. These hand-reared clutches were used as a source of volatiles. The volatiles were collected for chemical analysis and delivered to caring mothers to quantify their behavioural response. As predicted, mothers exposed to volatiles from nymphs in poor condition provisioned significantly more food than those exposed to air (controls) or volatiles from high-condition nymphs. Chemical analysis revealed that nymphs emitted a blend of eight compounds of which alpha-pinene and camphene showed the strongest relationship with food treatment. Exposure to pure synthetic alpha-pinene and camphene did not affect maternal provisioning, however, suggesting that the functional significance of alpha-pinene and/or camphene may occur in a blend with other compounds. This study shows a clear effect of condition-dependent offspring odours on maternal food provisioning and identifies, for the first time, candidate compounds for a potential chemical offspring begging signal.

Animal Communication↗

PubMed1967

The role of punishment in the in-patient treatment of psychiatrically disturbed children.

The role of punishment in the psychiatric in-patient treatment of nonpsychotic latency-age children with behaviourdisorders is discussed. Punishment is defined as the removal of previously existing positive reinforcers or the administration of aversive stimuli. Ways in which appropriate social behaviour may be acquired are briefly considered. These include reinforcement of desirable responses, non-reinforcement of undesirable responses, reinforcement of incompatible responses and imitative learning. The reported effects of punishment on behaviour are reviewed and the psychological functions necessary before punishment can have the intended effects considered. For seriously disturbed children punishment is ineffective as a treatment technique. It reinforces pathological perceptions of self and adults even if it successfully suppresses behaviour. The frame of reference of the seriously disturbed child contraindicates the removal of positive reinforcers and verbal as well as physical aversive stimuli. Controls and punishments must be clearly distinguished. Controls continue only as long as the behaviour towards which they are directed. They do not include the deliberate establishment of an unpleasant state by the adult as a result of particular behaviour. Control techniques such as removal from a group may be necessary but when possible should be avoided in favour of techniques less likely to be misinterpreted. Avoidance of punishment in treatment makes even more important explicit expectations and provision of realistic controls. Natural laws may result in unpleasant experiences as an unavoidable result of certain behaviour. By definition such results can never be imposed by the adult. Treatment considerations may necessitate that the child be protected from the results of his actions. Avoidance of punishment requires a higher staff/child ratio, more mature and better trained staff. Sometimes children have previously been deterred from serious community acting out only by punishment. Should the therapeutic endeavours outlined not prevent such behaviour, treatment in a closed setting without punishment is indicated, not the use of punishment in an open centre.

Child↗

PubMed1994

Psychosocial adjustment of five-year survivors of childhood cancer.

This study assessed the psychosocial adjustment of 31 childhood cancer patients five years after diagnosis compared with their school peers. The children were aged 8 to 18 years at the time of the study. No significant difference was found in self-rated measures of anxiety and self-esteem. However, there were significant differences in teacher ratings of concentration, academic progress, and popularity with peers and in parent and teacher ratings of behavioural adjustment (Rutter Scales A and B), indicating that the survivors of childhood cancer were at increased risk of problems. Relationships between behavioural adjustment scores and child, family, and illness variables were investigated within the cancer-survivor group. No significant relationship was found with illness variables or social class. Significant associations were found between behavioural adjustment and parental psychological distress, parental coping strategies, children's perceptions of their own scholastic competence, and their relationships with peers. In addition, children who had shown considerable problems in school work one year after diagnosis were more at risk for behavioural problems at this later state. The findings have implications for the provision of support to childhood cancer patients, their families, and their teachers that may help to prevent later problems in adjustment.

Achievement↗

PubMed2005

Cognitive behaviour therapy within acute mental health care: a critical appraisal.

This paper examines the evidence for the use of cognitive behavioural therapy (CBT) within acute mental health-care settings. Through the provision of a literature review the authors critique the research into the effectiveness of CBT when delivered within acute mental health-care settings, to clients who are acutely psychotic. The review concludes with recommendations for future research to expand the current evidence base.

Acute Disease↗

PubMed1993

Behaviour and emotional problems in three-year-old children of Asian parentage.

Three-year-old Asian children in inner Birmingham were found to have a similar prevalence of behaviour and emotional disturbance to white English children. The Asian children had fewer sleep problems than the white and their mothers had less difficulty in controlling them. There was a difference in parental attitude to difficult behaviour between the two groups and also several differences in associated social variables. In both groups there was a high level of psychological distress in the mothers of the children with behaviour problems and to a lesser extent the fathers. Implications for service provision are discussed.

Child Behavior Disorders↗

PubMed1985

Non-organic failure to thrive: a reappraisal.

Non-organic failure to thrive has traditionally been regarded as due primarily to maternal rejection and neglect. A critical reappraisal of the evidence suggests a more balanced view of the mother-child relationship should be taken. A classification of the condition, founded on facts not concepts, is urgently required. Non-organic failure to thrive should be viewed in a multidimensional context, in which potential influences upon the symptomatic infant are considered. Inadequacy of nutrition is caused by both a failure of adequate provision of food and by inadequate intake. A vicious circle of maladaptive behavioural interaction between caregiver and infant is often present, sustained by high emotional tensions. Clinical intervention should aim to clarify the contributions made by both caregiver and infant to that interaction and thus break the cycle. The basis on which intervention is made should be direct observation of the parent and child relationship in as many different environmental contexts as feasible, especially during feeding. The multidisciplinary team has an important role to play in management. An emphasis on parental culpability in the aetiology of non-organic failure to thrive, in the absence of direct evidence of neglect, is wrong.

Child↗

PubMed1996

Psychiatric problems in children with hemiplegia: cross sectional epidemiological survey.

OBJECTIVE: To examine the prevalence and predictors of psychiatric problems in children with hemiplegia. DESIGN: Cross sectional questionnaire survey of an epidemiological sample with individual assessments of a representative subgroup. The questionnaire survey was repeated on school age subjects four years later. SUBJECTS: 428 hemiplegic children age 2 1/2-16 years, of whom 149 (aged 6-10 years) were individually assessed. MAIN OUTCOME MEASURES: Psychiatric symptom scores and the occurrence of psychiatric disorder. RESULTS: Psychiatric disorders affected 61% (95% confidence interval 53% to 69%) of subjects as judged by individual assessments and 54% (49% to 59%) and 42% (37% to 47%) as judged from parent and teacher questionnaires, respectively. Few affected children had been in contact with child mental health services. The strongest consistent predictor of psychiatric problems was intelligence quotient (IQ), which was highly correlated with an index of neurological severity; age, sex, and laterality of lesion had little or no predictive power. CONCLUSION: Though most hemiplegic children have considerable emotional or behavioural difficulties, these psychological complications commonly go unrecognised or untreated. Comprehensive health provision for children with chronic neurodevelopmental disorders such as hemiplegia should be psychologically as well as physically oriented.

Child↗

PubMed2004

Developing explanatory models of health inequalities in childhood dental caries.

OBJECTIVE: Long-term aim is to determine optimum interventions to reduce dental caries in children in disadvantaged communities and minimise the effects of exclusion from health care systems, of ethnic diversity, and health inequalities. DESIGN: Generation of initial explanatory models, study protocol and development of two standardised measures. First, to investigate how parental attitudes may impact on their children's oral health-related behaviours and second, to assess how dentists' attitudes may impact on the provision of dental care. SUBJECTS: Core research team, lead methodologists, 44 consortium members from 18 countries. To complete the development of the questionnaire, the initial set of items was administered to parents (n = 23) with children in nursery schools in Dundee, Scotland and sent to the same parents one week later. A standardised measure examining barriers to providing dental care for children aged 3 to 6 years was developed. 20 dentists working in primary dental care in Scotland completed the measure on two different occasions separated by one week. RESULTS: Explanatory models were developed. Family questionnaire: test-retest reliability excellent (r = 0.93 p < or = 0.001) with very good internal reliability (alpha = 0.89). Dentists questionnaire: excellent test-re-test reliability r = 0.88, (alpha = 0.90). CONCLUSIONS: Interaction between consortium members enhanced the validity of the questionnaires and protocols for different cultural locations. There were challenges in developing and delivering this multi-centre study. Experience gained will support the development of substantive trials and longitudinal studies to address the considerable international health disparity of childhood dental caries.

Attitude of Health Personnel↗

PubMed1997

Characteristics of in-patients transferred to a locked ward in a Scottish psychiatric hospital.

OBJECTIVE: To identify and characterise in-patients transferred from open wards to the locked facility (IPCU) of a psychiatric teaching hospital, and to classify reasons for transfer. DESIGN: Retrospective case note study using the Lothian Psychiatric Case Register. A reason for transfer classification was devised. SETTING: Intensive Psychiatric Care Unit (IPCU) of the Royal Edinburgh Hospital. SUBJECTS: All in-patients transferred from other wards of the Royal Edinburgh Hospital to the IPCU during one year. RESULTS: Over one year there were 131 transfer episodes involving 97 patients. Ninety-eight per cent of episodes could be allocated to one of six categories of reason for transfer, with physical violence to others being commonest (30%). Patients' mean age was 31 years. There was a predominance of schizophrenics (51%) and males (66%). In 20% of transfers, patients were not detained under mental health legislation. Associations emerged between schizophrenia and physical violence, hypomania/mania and generally disruptive behaviour, personality disorder and self harm. In half of all transfers the patient had already been an in-patient for at least 1 month. Fifty-seven per cent of patients were transferred more than once over the preceding five years. Most (90%) transfers originated from acute wards, and patients stayed in the IPCU less than two weeks (70%) before returning to the open wards (23% less than 24 hours). CONCLUSIONS: Local locked wards deal with a range of disturbed behaviour and can be an important component in the spectrum of secure provision. Further evaluative research is required.

Adolescent↗

PubMed1995

Family provision of health and welfare in the mixed economy of care in the late nineteenth and twentieth centuries.

The paper begins by discussing the place of the family as a provider of welfare in the context of the changing nature of the 'mixed economy of welfare'. It goes on to explore the nature of social provision by the family at the turn of the century, stressing the way in which the behaviour of people within families was taken as the test of citizenship in an ethical state, and was therefore made the target of volumtary and state intervention. The paper concludes by contrasting this with ideas about family responsibility in the late twentieth century, and the concern to promote family provision as an alternative to state provision.

Family Health↗

PubMed2004

Social skills assessment of children with autism in free-play situations.

Poor social functioning and limited play are characteristic of children with autism. Increasingly, education for children with autism is provided within mainstream settings, but given their particular difficulties, the adequate provision of educational services in such settings is challenging. This study presents observational data of the play behaviour and social interaction patterns of 10 children with autism in mainstream kindergartens and primary school playgrounds. The target children differed significantly in terms of their play and social interactions from typically developing children in the same settings. The adequacy of the provision of services for children with autism in mainstream provision is discussed.

Adaptation, Psychological↗

PubMed1995

The extent of support for ordinary living provided in staffed housing: the relationship between staffing levels, resident characteristics, staff: resident interactions and resident activity patterns.

Staffed housing has become an accepted alternative to institutional residential services for people with learning disabilities on the expectation that such provision will promote 'ordinary' patterns of living. Information on staffing levels and the behavioural characteristics of residents together with direct observational data on staff: resident interactions and resident engagement in activity were collected on 15 housing services in South Wales and analysed to explore the interrelationship between these key input and outcome variables. Staffing levels were found to be related to resident characteristics in general but not consistently so. The extent of staff: resident interaction per staff was related to resident characteristics, with staff in services for more able residents spending more time with them. The level of staff support given to residents with more substantial disabilities, slightly higher than that given to more able residents, reflected high staffing input. Resident engagement in activity was strongly related to ability. Participation in household activity was virtually non-existent among residents with the greatest disabilities. The results were compared to similar data from earlier studies on a range of residential services. The relative benefits of small, community-based housing services over institutional and larger community settings were confirmed by the Welsh data. However, comparison to other housing services, which had a particular emphasis on staff helping residents become involved in domestic activity, supports the conclusion that 'ordinary living' for people with severe or profound learning disabilities depends not only on the provision of ordinary environments but also on the orientation and working methods adopted.

Activities of Daily Living↗

PubMed1993

Aggressive behaviour among patients referred to a psychogeriatric service.

The characteristics of a series of patients referred to a psychogeriatric service over a one-year period were examined. Patients exhibiting aggressive behaviour as a feature of the presentation were compared to those without. Aggressive patients were less likely to be living in their own homes, less likely to receive services, more likely to be referred from social services institutions, and be on multiple psychotropic drugs, particularly neuroleptics. The implication of this for adequate provision of psychiatric and social service is discussed. Only a small number of patients exhibited aggressive behaviour as a feature of their presentation.

Aged↗

PubMedDate not supplied

[Changes in the correlations of the different indices of the entire behavior of dogs under the influence of seduxen].

During chronic use of seduxen various changes of correlation connections between different parameters of general behaviour are revealed in dogs. The character and degree of expressiveness of these changes depend on the drug dose and typological characteristics of animals. The most general and significant manifestation of favourable effect of the drug action on animals behaviour is an increase of the number of "strong" correlation connections (correlation coefficient is more than 0.7) of the parameters of various components of conditioned activity, reflecting the state of inner inhibition processes, and to the parameters of vegetative provision of conditioned reactions. The character of reconstructions of correlation connections between different conditioned, vegetative, neurotransmitter and general behaviour parameters allows to judge of the direction of pharmacological influence on separate functional systems and the behaviour as a whole.

Animals↗

PubMed2005

Learned kin recognition cues in a social bird.

In many cooperatively breeding birds, kin selection has an important role in the evolution and maintenance of social behaviour, and 'helpers' can maximize indirect fitness gains by preferentially allocating care to close relatives. Although there is evidence for kin-biased helping behaviour in several species, the mechanism of kin recognition underlying this behaviour is poorly understood. Vocalizations are the most commonly used cues in avian recognition systems, but the effectiveness of vocal signals as reliable recognition cues must depend on how they are acquired. However, there have been no experimental studies of the development of vocal recognition cues in cooperative birds; indeed, the ontogeny of all bird vocalizations other than song is poorly known in any species. Here, we show that cooperatively breeding long-tailed tits (Aegithalos caudatus) can discriminate between kin and non-kin according to the individual-specific characteristics of contact calls, and show experimentally that individuals learn these calls from provisioning adults during the nestling period. Finally, we show that the pattern of cooperative behaviour in this species is consistent with the use of recognition cues learned through association.

Animals↗