Perceptions of Stress,Coping, and Intervention Preferences among Caregivers of Disadvantaged Children with Asthma

Asthma remains the most prevalent chronic illness among children. Despite the substantial body of literature examining children with asthma, few studies have examined parents’ perspectives of the condition and experiences of caregiver stress. Parents of children with chronic illnesses experience elevated stress and may have limited opportunities to cope with complex emotions while caring for children with asthma. Drawing from focus groups and interviews with African American and Hispanic parents of children with asthma, this qualitative study was conducted as part of a patient-centered engagement process to inform the refinement of an intervention aimed at reducing stress among parents of children with asthma. All data were transcribed and underwent three waves of inductive analysis. The content analysis indicated that the unpredictable nature of asthma and the caregiving burden associated with managing children’s asthma contributed to parents’ stress, and external contexts compounded the impact of these stressors. Parents also reported having difficulty identifying how they coped with stress and employed approaches to coping with stress that they applied intermittently but encountered several barriers to enacting known or available coping strategies. Analyses also revealed that parents desired a multimodal stress reduction intervention that emphasized building relationships, allowed for flexibility, and encouraged staff-parent communication. Whereas African American and Hispanic parents’ experiences of stress and coping strategies were similar, their preferences differed in regards to incorporating technology into the intervention, the credentials of facilitators, and the salience of language preferences. Understanding the complexities of stressors facing caregivers is important for developing interventions to support parents and children coping with asthma, and in particular when working with families from diverse backgrounds.     

Opting out or denying discrimination? How the framework of free choice in American society influences perceptions of gender inequality

American women still confront workplace barriers (e.g., bias against mothers, inflexible policies) that hinder their advancement at the upper levels of organizations. However, most Americans fail to recognize that such gender barriers still exist. Focusing on mothers who have left the workforce, we propose that the prevalent American assumption that actions are a product of choice conceals workplace barriers by communicating that opportunities are equal and that behavior is free from contextual influence. Study 1 reveals that stay-at-home mothers who view their own workplace departure as an individual choice experience greater well-being but less often recognize workplace barriers and discrimination as a source of inequality than do mothers who do not view their workplace departure as an individual choice. Study 2 shows that merely exposing participants to a message that frames actions in terms of individual choice increases participants' belief that society provides equal opportunities and that gender discrimination no longer exists. By concealing the barriers that women still face in the workplace, this choice framework may hinder women's long-term advancement in society.     

Rats are sensitive to ambiguity

In the present study, we investigated response decisions made under conditions of incomplete information in rats. In Experiment 1, rats were trained on either a positive patterning (PP; A-, B-, AB+) or a negative patterning (NP; A+, B+, AB-) instrumental lever-press discrimination. Subjects that had learned an NP discrimination responded less to Cue A when Cue B was covered at test. The cover did not, however, affect test responses to Cue A in the PP condition. In Experiment 2, rats received concurrent training on both PP and NP discriminations. After concurrent training, responses to Cue A were different with B covered versus uncovered for both NP and PP discriminations. We discuss possible accounts for why exposure to a nonlinearly soluble discrimination (NP) may have affected sensitivity to cue ambiguity produced by the cover. These results have interesting implications for representational processes engaged in problem solving.     

Public Health Ethics Education in a Competency-Based Curriculum: A Method of Programmatic Assessment

Public health ethics began to emerge in the 1990s as a development within bioethics. Public health ethics education has been implemented in schools of public health in recent years, and specific professionalism and ethics competencies were included in the Master of Public Health (MPH) competency set developed nationally and adapted by individual schools of public health around the country. The University of Texas School of Public Health approved the present set of MPH competencies in 2005. After 4 years of experience, we now report information measuring the extent to which “Professionalism and Ethics” competencies and subcompetencies are being met in the MPH degree program. To this end we have audited the MPH “Professionalism and Ethics” competency forms for FY2009 MPH graduates (n = 61). Eight courses, including required MPH core courses plus the practicum and culminating experience, were found to have substantial professionalism and ethics content. Further, 67.2% of graduates met eight or more of the 13 competencies and subcompetencies, but only 36.1% met all thirteen, indicating a need to identify topic areas to be added to, or enhanced in, the MPH curriculum. In addition, these findings will inform ongoing efforts to enhance ethics education in our health science center. Assessment of these competencies and subcompetencies is an essential step in strengthening ethics education at our institutions and in better preparing our graduates for a challenging future. We report our efforts here to demonstrate one way of carrying out programmatic assessment of ethics education in a school of public health.     

Bilingual Therapeutics: Integrating the Complementary Perspectives and Practices of Motivational Interviewing and Dialectical Behavior Therapy

Informed by the practice of code-switching or style-switching in linguistics, “bilingual therapeutics” is proposed as the complementary integration of two evidence-based practices in psychotherapy: motivational interviewing (MI) and dialectical behavior therapy (DBT). Unique features of MI and DBT are presented, current research of each practice is reviewed, and their similarities and distinctions are discussed. It is proposed that fluency in both “languages” of MI and DBT may usher in a new therapeutic perspective to enhance client case conceptualization, illuminate subtleties of the therapeutic process, and foster more intentional and deliberate practitioners. Specifically, MI and DBT code-switching may help recruit and retain clients in formal treatment (e.g.,”speaking” MI more prominently to prepare clients for 12-month standard DBT) and promote consultation among therapists. The complementary integration of MI and DBT also suggests the emergence of a linguistic “third space,” including “spirit as synthesis” and “improvisational dance.”     

International stem cell tourism and the need for effective regulation. Part II: Developing sound oversight measures and effective patient support

Part I of this article, published in the March 2010 issue of the Kennedy Institute of Ethics Journal, traces and addresses the provision of unproven stem cell treatments in Russia and India, examines the concept of innovative treatment, and concludes that stronger regulations are needed to protect the health and informed choices of patients. The current paper, Part II, proposes that the regulatory frameworks for the development of safe and efficacious treatments in effect in the United States and the United Kingdom provide examples of strong oversight measures from which countries seeking to obtain international credibility for their biotechnological competence could draw when developing regulations for stem cell treatments. Major sources of information available to persons who consider receiving such unproven treatments are explored in order to understand and address their concerns. The paper concludes with proposed measures to inform those considering the pursuit of unproven stem cell treatments abroad more accurately about their efficacy and safety and provide them with improved medical and social support in their home countries.     

Parental Interpersonal Sensitivity and Youth Social Problems: A Mediational Role for Child Emotion Dysregulation

We examined the relations between parental interpersonal sensitivity and youth social problems and explored the mediational role of child emotion dysregulation. Mothers (N = 42; M age = 39.38) and fathers (N = 41; M age = 39.38) of youth aged 7–12 (N = 42; M age = 9.12) completed measures of their own interpersonal sensitivity and reported on their child’s emotion regulation skills and social functioning. Maternal interpersonal sensitivity was positively associated with child social problems, and this relationship was fully mediated by child emotion dysregulation. A bootstrapping technique provided evidence for the significance of the mediation. For fathers, only the association between child emotion dysregulation and child social problems was significant. Our findings suggest one potential mechanism through which maternal behaviors relate to youth psychosocial functioning. Identification of such mechanisms contributes to the development of conceptual models of youth functioning and suggests specific targets for prevention and intervention efforts.