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PubMed2005

A young surgeon's perspective.

The environment of health care delivery is responding to a variety of external forces that are changing the practice of surgery. Only when we look back at this period can any assessments be made to determine whether the changes were beneficial or detrimental. The observation that surgeons are retiring at an earlier age may be a reflection of the negative effect of the changing culture of surgery on career satisfaction. As a young surgeon who anticipates an additional 20+ years of a surgical career, these changes are important to me and will clearly affect my practice as well as my satisfaction. This special article provides my personal perspective on some of the current and anticipated changes in surgery that are a manifestation of cultural changes in health care delivery.

Attitude of Health Personnel↗
PubMed2000

Acculturation and disordered eating patterns among Mexican American women.

OBJECTIVE: This quantitative study examined the relationship between acculturation and disordered eating patterns among different generations of Mexican American women. METHOD: Participants included 139 Mexican American women (mean age = 29.1) drawn from local undergraduate courses and community agencies. The posttest-only design included a demographic measure, Acculturation Rating Scale for Mexican Americans (ARSMA), and the Eating Attitudes Test (EAT-26). RESULTS: Of the five generations studied, second-generation women endorsed the most disordered eating patterns and the highest degrees of concurrent acculturation. Moreover, there was a significant, positive correlation between acculturation and Factor III of the EAT which highlights control of eating and perceived pressure from others to gain weight. Participants scoring beyond the EAT cut-off score endorsed bulimic symptoms. DISCUSSION: Differing intergenerational ideals regarding weight may create special strains for second-generation Mexican American women. Criteria for disordered eating in a population previously not considered at risk should be further assessed and clinicians should be careful not to underdiagnose among this group.

Acculturation↗
PubMed1996

Motivating factors, exchange patterns, and reciprocity among caregivers of parents with and without dementia.

The purpose of this study was to explore the impact of background characteristics, motivating factors, exchange patterns, and diagnosis of dementia on caregiver reciprocity. Adult children of parents with dementia (n = 110) and without dementia (n = 195) completed the Caregiver Reciprocity Scale, Motivating Factors Index, Exchange Patterns Index, and a demographic data sheet. ANCOVA analysis indicated adult children of parents with dementia gave more direct instrumental and supervisory care, received more negative and fewer positive exchanges, and reported significantly lower levels of warmth and regard, intrinsic rewards of giving, and balance within family caregiving when compared to adult children of parents without dementia. Hierarchical multiple regression analyses indicated that 64% of the variance of warmth and regard; 42% of intrinsic rewards of giving; 48% of love and affection; and 31% of balance within family caregiving was explained by antecedent demographic variables, motivating factors, exchanges given and received, and dementia. Surprisingly, the diagnosis of dementia did not contribute to explained variance in caregiver reciprocity.

Adult↗
PubMed1998

Finding a balance point: a process central to understanding family caregiving in Taiwanese families.

The grounded theory method was used to explore the psychosocial process of family caregiving to frail elders in Taiwan. Interview and observation data from 15 family caregivers were analyzed using constant comparative analysis. Caregivers used the process of finding a balance point to achieve or preserve equilibrium between and within caregiving and family life. Caregivers who did better in finding a balance point provided better quality care to frail elders. Caregivers who were good at finding a balance point anticipated competing needs, conceptualized multiple strategies to meet the needs, and predicted accurately the consequences of the strategies. They described a wide variety of balancing strategies.

Activities of Daily Living↗
PubMedDate not supplied

The discounting of lives saved in future generations--some empirical results.

The aim of this note is to estimate the discount rates that individuals in the present generation in Sweden use to discount lives saved in future generations at different points in time. A binary survey question, where individuals choose between saving lives in their own generation versus saving lives in future generations, was administered in a general population sample of 850 individuals. Three time horizons of 20, 50 and 100 years were used in three different subsamples. Logistic regression analysis was used to estimate the discount rate. The estimated annual discount rate is 25% for the 20 year time horizon, 12% for the 50 year time horizon and 8% for the 100 year time horizon.

Adolescent↗
PubMedDate not supplied

Intergenerational equity: an exploration of the 'fair innings' argument.

Many different equity principles may need to be traded off against efficiency when prioritizing health care. This paper explores one of them: the concept of a 'fair innings'. It reflects the feeling that everyone is entitled to some 'normal' span of health (usually expressed in life years, e.g. 'three score years and ten') and anyone failing to achieve this has been cheated, whilst anyone getting more than this is 'living on borrowed time'. Four important characteristics of the 'fair innings' notion are worth noting: firstly, it is outcome based, not process-based or resource-based; secondly, it is about a person's whole life-time experience, not about their state at any particular point in time; thirdly, it reflects an aversion to inequality; and fourthly, it is quantifiable. Even in common parlance it is usually expressed in numerical terms: death at 25 is viewed very differently from death at 85. But age at death should be no more than a first approximation, because the quality of a person's life is important as well as its length. The analysis suggests that this notion of intergenerational equity requires greater discrimination against the elderly than would be dictated simply by efficiency objectives.

Adolescent↗
PubMed2001

Intergenerational effects of complete maternal deprivation and replacement stimulation on maternal behavior and emotionality in female rats.

The present study investigated the effects of early rearing experiences on the development of maternal behavior in Sprague-Dawley female rats. Pups from individual litters were assigned to four different groups on Day 3 of life. From days 4 to 20 of life, these were reared artificially, without mother and receiving minimal "licking-like" tactile stimulation (AR-MIN), or maximal stimulation (AR-MAX) or were reared with their mothers (MR-CONTROL and MR-SHAM). At 70-100 days all AR and MR animals were mated and then observed with their own offspring, culled to eight pups. After maternal testing open-field tests were conducted. The female offspring in these litters (all raised by their MR and AR mothers) were reared to adulthood and then observed interacting with their offspring. Results show that in adulthood AR mothers engaged in significantly fewer pup-retrievals and less pup-licking (genital and body), and crouching, but significantly more non-maternal tail-chasing, digging, and hanging/climbing. As well, they were more active in the open field. Comparisons between the two AR groups and the MR groups, showed that most of the differences were between the AR-MIN and MR groups, with the AR-MAX animals showing levels of behavior between the two, and differing from neither. Analyses of covariance indicated that early experience and adult emotional behavior both influence adult maternal behavior, but their effects are independent of one another. A cross-generational effect of artificial rearing was also found. Daughters of AR and MR mothers that were observed after the birth of their own litters in adulthood showed a pattern of behavior that mimicked the pattern shown by their mothers. These results are discussed in terms of the variety of possible behavioral, endocrine, and neurochemical mechanisms that mediate the effects of early experiences on adult maternal behavior.

Analysis of Variance↗
PubMed2000

Redefinition: coping with normal results from predictive gene testing for neurodegenerative disorders.

The purpose of this qualitative study was to describe the psychosocial impact and coping processes of normal (negative) results from predictive testing for an inherited neurodegenerative disease. Ten adults with normal results of predictive testing for the Huntington disease (HD) or the Pallido-Ponto-Nigral Degeneration (PPND) gene mutation participated in semi-structured interviews 1 month after receiving results, and seven of these participants were interviewed 6 months later. The major theme of Redefinition was derived using Knafl and Webster's analysis method (1988). People who received normal gene results experienced loss of former beliefs about themselves and developed new self definitions, relationships with family, and roles in society. This coping process evolved from a personal focus at 1 month to a broader future perspective at 6 months after testing. Identifying components of the redefinition process may be an important consideration in planning interventions to promote coping with normal gene results in persons within at-risk families.

Adaptation, Psychological↗
PubMed2000

Social support transactions between professional and nonprofessional women and their mothers.

A theoretical model predicting professional and nonprofessional women's perceptions of social support transactions with their mothers was tested. A sample of 210 Professional women and 165 nonprofessional women answered mailed questionnaires. LISREL VI was used to evaluate the quality of the measurement model and generate a revised model. Social support was greatest when employed women were professional, had positive filial responsibility attitudes, lived near their mothers, visited them frequently, and when mothers were not married. These findings provide a beginning theoretical model that can serve as a basis for nursing practice and research when working with intergenerational families.

Adult↗
PubMed2002

Application of robust pedigree analysis in studies of complex genotype-phenotype relationships in fragile X syndrome.

Relationships between the fragile X dynamic mutation and palmar and finger epidermal ridge measures were assessed using a robust modification of the maximum likelihood estimators for pedigree data. A total of 34 extended families affected with fragile X syndrome were used. Phenotypic traits included ridge count on the thumb and ridge breadth measured in the second palmar interdigital area bilaterally. Genotypic measures were represented by the number of CGG repeats in the FMR1 gene, the levels of specific FMR1 protein (FMRP), fragile X category defined by the size of the CCG repeat, and methylation status of the gene. The results demonstrated a significant fragile X effect (related to the number of CGG repeats) in the thumb ridge count in males. This effect was more evident in ridge breadth and was found in both sexes. However, the relationship between both phenotypic traits and the level of FMRP was nonsignificant. The study makes a useful contribution to the development of methodologies for the analysis of genotype-phenotype relationships in dynamic mutations, especially in overcoming extensive variability in both the genotype and phenotype, and in approaching the statistical problems related to intergenerational changes in repeat size. The findings support the hypothesis that the fragile X mutation affects limb development during an early fetal period.

Dermatoglyphics↗
PubMedDate not supplied

Bridging the generation gap.

Generational differences will always exist among nurses and patients. However, with our limited resources, the aging of our patient population, and increased longevity, it is pivotal that we identify effective strategies to transcend generational differences that may compromise patient care. By joining forces, we can maximize our knowledge and skills and in the process enhance our ability to value the contribution of these generational differences to improve quality nursing care and rehabilitation practice. Although the solutions may not be simple, we must persist in discovering creative solutions to overcome the multiple conflicts emerging from patient and nursing generational differences.

Humans↗
PubMed2004

The psychoanalyst as individual: self-analysis and gradients of functioning.

The authors discuss the position of the analyst as an individual and the idea that his mental functioning can be seen as a meaningful element of the analytic field. The first part of the article shows the importance of the analyst's self-analysis, with particular attention to periods when the analyst is facing a difficult time, self-analysis in supervision, and the exploration of transgenerational influences. The authors go on to discuss the many gradients of the analyst's mental functioning, and these are mirrored in the patient's text, an indication of attunement.

Adult↗
PubMed2004

Youth.

Explore the source record for details and available documents.

Adult↗
PubMed2003

Factors of positive appraisal of care among Japanese family caregivers of older adults.

The purpose of this study was to examine factors of positive appraisal of care among Japanese family caregivers of older adults. The Positive Appraisal of Care (PAC) scale used in this study is a multidimensional Japanese measure and has four domains: relationship satisfaction, consequential gain, role confidence, and normative fulfillment. Three hundred and thirty-seven caregivers participated in this survey. Multiple regression analyses revealed that social support and caregiver belief in caregiving had a consistent impact on all domains of the PAC, whereas the impact of caregiver and care recipient characteristics varied among the domains. For example, caregiver age had a significant impact on role confidence and normative fulfillment but not on relationship satisfaction and consequential gain. The differential impact of caregiver and care recipient characteristics on the domains of the PAC underlines the usefulness of a multidimensional measurement.

Adaptation, Psychological↗
PubMed2006

Ethnic and generational influences on emotional distress and risk behaviors among Chinese and Filipino American adolescents.

The purpose of this study was to explore ethnic and generational influences among Chinese, Filipino, and Euro American adolescents on emotional distress and risk behaviors. Hierarchical multiple regression analyses were conducted with 216 Chinese, 387 Filipino, and 400 Euro American adolescents from the National Longitudinal Study on Adolescent Health to investigate the influence of ethnicity on depression, somatic symptoms, delinquency, and substance use; and to examine the influence of generation on the outcome variables among Chinese and Filipino American adolescents. Ethnicity predicted depression and delinquency scores, while generation within ethnic groups predicted somatic symptoms and substance use. The findings diverge from theories using acculturation as an explanatory mechanism for distress and risk behaviors and underscore the importance of examining sub-groups and generations of Asian American youth.

Adolescent↗
PubMed2004

We are talking, but are they listening? Communication patterns in families with a history of breast/ovarian cancer (HBOC).

This study explores how family communication patterns and family scripts influence the dissemination of genetic information and the sharing of feelings about genetic inheritance in families of healthy women who have attended a cancer genetics risk clinic because of their family history of breast and, or ovarian cancer. Family scripts are sets of expectations, beliefs, and norms that assign meaning to patterns of interaction, connect generations and provide guidance for action. We conducted an exploratory, qualitative study at a major clinical and research cancer center in the United Kingdom from January through June 2000 approved by the hospital clinical research and ethics committees. Twenty-one semi-structured, in-depth interviews were conducted using a purposive sample of women coming to the cancer genetics risk clinic for the first time, supplemented by 5 months of participant observation. We identified several communication patterns: open and supportive; directly blocked, indirectly blocked, self-censored and use of third parties. Some family members shared their feelings and discussed ways of trying to avoid developing breast or ovarian cancer; for others disseminating information or just talking about inherited susceptibility for breast and, or ovarian cancer fell into the script violation category; still others tried to renegotiate their family scripts.

Adult↗
PubMed2002

The rhetoric and reality of youth mentoring.

Enduring and supportive mentoring relationships can powerfully influence the course and quality of adolescent lives. As mentoring continues to expand, community agencies are implementing alternatives to the traditional one-on-one mentoring mode. Such efforts may help to reach youth who might otherwise fall through the cracks.

Adolescent↗