Predictors of Satisfaction with Obstetric Care in High-risk Pregnancy: The Importance of Patient–Provider Relationship

The study set out to examine the predictive effects of patients’ emotional distress and their relationships with their health care providers on satisfaction with obstetric services in high-risk pregnancies. Participants were 104 pregnant women with a history of recurrent losses, fetal demise, previous or current fetal genetic abnormality, advanced maternal age, or obstetric or medical complications of the present pregnancy. Self-report measures of emotional distress and the quality of their relationships with their medical provider were administered. Hierarchical multiple regression analyses were conducted to assess the predictive effect of these variables on satisfaction with services. Provision of information, constructive communication, and good relationships predicted elevated satisfaction with health services. Provision of information also buffered against the adverse effect of emotional distress on satisfaction with health services. These findings elucidate the central role of provider–patient interaction, particularly as it is related to provision of information, in high-risk pregnancy.     

Chapters of Our Lives: Life Narratives of Midlife and Older Australian Women

A narrative approach was used to explore whether women perceive their later years as a time of loss, stability, or gain, and the explanations they give for their perceptions. Life review interviews were held with 20 married or previously married mothers aged 60–65 living in lower-income suburbs of Sydney, Australia. Participants were asked to consider their life story as a book, to divide the book into chapters, and to entitle each chapter. Two types of gain narrative accounted for 70% of the stories: one (breakouts) described gains that resulted from the womans own actions, and the other (stress relief) described gains from role changes and the passage of time. A further 20% described continuing contentment with their lives, and 10% of the accounts described later life in terms of losses. The findings suggest that one reason for the later life satisfaction regularly found by surveys of older adults may be the disappearance or diminishment of previous life stressors. As part of a planned cohort comparison, similar interviews were held with women aged 50–55 and 40–45. An additional category of ongoing stress was required to accommodate their narratives.     

Correlates of Patient Satisfaction Among Menopausal Women

Patient satisfaction can increase compliance and health outcomes in many populations. Menopausal-age women present unique physical and psychosocial concerns that separate them from other populations in their health care needs and preferences. We surveyed 48 women (ages 45–60) regarding their satisfaction with a recent annual exam office visit in a family practice clinic. Women reported the number of quality of life issues they discussed during this visit and which of these they considered most important, as well as menopausal symptoms and perceived health competence. Regression analyses identified variables most related to patient satisfaction. Of three components of visit satisfaction (Quality, Humaneness, and General Satisfaction), Quality was predicted by quality of life issues discussed. Physical, psychological, and functional domains were considered most important to the patients, whereas physical, psychological, and social domains were most often actually discussed in the visit.     

Dimensions of Support Among Abused Women in the Workplace

The authors draw on social support theory to examine supervisor support match (support wanted and received), support mismatch (support not wanted and received) and work outcomes for abused low‐wage working women, and to determine if supervisor support match and mismatch are more strongly associated with work outcomes than global supervisor support Face‐to‐face interviews were conducted with a community sample of abused, employed women who have experienced intimate partner violence (IPV) in the past year (N = 163). Using hierarchical regression, we found, after accounting for global supervisor support; a higher level of supervisor support match was associated with greater job satisfaction, fewer job reprimands and less job termination. Findings from the study inform theories of social support and have practical implications for workplace interventions for IPV.     

Comprehension of human pointing gestures in horses (Equus caballus)

Twenty domestic horses (Equus caballus) were tested for their ability to rely on different human gesticular cues in a two-way object choice task. An experimenter hid food under one of two bowls and after baiting, indicated the location of the food to the subjects by using one of four different cues. Horses could locate the hidden reward on the basis of the distal dynamic-sustained, proximal momentary and proximal dynamic-sustained pointing gestures but failed to perform above chance level when the experimenter performed a distal momentary pointing gesture. The results revealed that horses could rely spontaneously on those cues that could have a stimulus or local enhancement effect, but the possible comprehension of the distal momentary pointing remained unclear. The results are discussed with reference to the involvement of various factors such as predisposition to read human visual cues, the effect of domestication and extensive social experience and the nature of the gesture used by the experimenter in comparative investigations.     

Community Gender Norms Change as a Part of a Multilevel Approach to Sexual Health Among Married Women in Mumbai,India

Inequitable gender norms in societies and communities negatively contribute to women’s sexual and reproductive health. While the need for change in gender norms is well recognized, the task is highly challenging in terms of intervention design, implementation and assessment of impact. This paper describes a methodology for identification of gender norms, the design of community level intervention, community participation and the assessment of intervention impact in a low income, predominately Muslim community of 600,000 people in Mumbai, India. Formative research focused on in‐depth interviews with women, men and couples yielding gender normative statements and assessment of community resources to facilitate change. A Gender Equity Scale (GES) based on this formative research was developed and administered annually for a three‐year period to random, cross‐sectional samples in the intervention and control communities, and to community based, non‐governmental organizations (NGO) staff and Imams (religious leaders) in the intervention community. NGO staff disseminated gender oriented messages to their female constituency through their regular outreach activities and through special events and festivals in the community. Imams disseminated gender messages through lectures on social issues for men attending Friday prayers. The results showed that the NGO staff and Imams, assumed more gender equitable attitudes across time. The intervention was associated with a significant improvement in attitudes towards gender equity in the intervention relative to the control community. Men showed a dramatic change in more positive gender attitudes, while women lagged behind in their GES scores. The meaning of these results are explored and the implications assessed for the generalizability of the methodology for other countries, cultures and communities.     

Prediction of Posttraumatic Stress Disorder From Peritraumatic Dissociation and Distress Among Men and Women Victims of Violent Crimes

This prospective study evaluated the main and interactive effects of peritraumatic reactions with gender on posttraumatic stress disorder (PTSD) onset, independently of known risk factors. Further, 111 adult victims of violent crime completed the Structured Clinical Interview, the Modified PTSD Symptom Scale, the Peritraumatic Dissociative Experience Questionnaire, and the Peritraumatic Distress Inventory. Hierarchical regressions and chi-square tests were conducted for continuous and categorical measures of PTSD. Extremely elevated scores of peritraumatic dissociation (PD) and peritraumatic distress (PDI) were obtained for both sexes. Greater PDI and PD were related to more PTSD symptoms. No significant interaction effects with gender emerged. These results remained when acute stress disorder was controlled for. Analyses on categorical data produced similar results. Victims of violent crimes recall severe peritraumatic reactions. The more severe these are, the more likely they are to develop significant PTSD symptomatology in the months that follow.     

Fostering Well‐being through Social Support: The Role of Evangelical Communities in the Lives of Dominican Women of Haitian Descent

Women of Haitian descent living in the Dominican Republic experience oppression due to their gender, ethnicity, and economic status. They also exhibit high rates of participation in evangelical Christian communities, a paradoxical finding given the restricted roles women have traditionally played in these settings. The goals of this study were to explore the perceived benefits of participation in evangelical communities and the setting characteristics that lead to these benefits. The research team interviewed 19 current and former church participants aged 18–59. Thematic analysis revealed three perceived benefits of congregational life. Participants viewed their participation as: (a) an opportunity for personal growth and development; (b) protective against negative social influences; and (c) providing social support in the face of life challenges. In addition, dependable, expected, and reciprocal relational support was a key characteristic of evangelical communities. Findings extend the current understanding of how religious communities enhance well‐being for marginalized women through social support networks. Findings also explore the dialectical nature of settings as both empowering and disempowering. Implications for future interventions are discussed.     

非熟练中-英双语者英语句子语义通达的语境效应

设计不同的语境条件, 并采用图-词语义一致性判断来探测非熟练中-英双语者英语句子的语义通达性, 结果表明, 在无语境条件、语义无关动画或语义相关文本伴音语境下, 非熟练中-英双语者表现出英语句子语义通达的非选择性, 而形象和语义一致的动画语境能使他们有效限制对等的L1句子构成词汇的激活, 并表现出目标句语义通达的选择性。这说明, 语境可以影响弱势语识别阶段的非选择激活, 相关的语境影响双语通达的理论也由此被讨论。     

Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM): Scale Development,Reliability, and Validity

Empathy has been shown to affect the quality of care by enhancing the physician–patient relationship and promoting effective communication. In this study, the newly developed Rating Scales for the Assessment of Empathic Communication in Medical Interviews (REM), designed to assess empathy and confrontation in physician–patient interactions, were subjected to preliminary psychometric testing. Particular attention was paid to face validity, reliability, sensitivity, and practicality. A total of 118 volunteers were asked to assess transcribed interactions between physicians and a standardized patient using the REM. In order to assess the convergent validity of the REM, the Motivational Interviewing Treatment Integrity Code (MITI) and the Behavior Change Counseling Index (BECCI) were used. Factor analysis identified two subscales, reflecting empathy and confrontation. Interrater reliability coefficients for items ranged from r = .82 to .97; Cronbach’s alphas for the two subscales were .89 and .88, respectively. The convergent validity was supported by substantial correlations between the REM scores and the MITI scores and by significant correlations between the REM scores and the BECCI score. The REM demonstrated good psychometric properties suggesting the rating scales might be useful in clinical practice, research endeavors, and medical education. Further research is necessary to assess the test-retest reliability as well as the predictive validity of this instrument.