社会因素对剖宫产率的影响

近二三十年来,剖宫产率在世界范围内不断升高。究其原因,除了医学因素外,社会因素起着重要作用,从社会经济发展,社会科学文化水平、社会习俗观念、法律、医疗道德、国家计划生育政策、医学教育等多个角度分析了社会因素对剖宫产率的影响,并就如何发挥社会因素的积极作用,消除和避免其消极作用,使剖部率维持在合理的范围内进行了讨论。     

Concordant Spiritual Orientations as a Factor in Physician--Patient Spiritual Discussions: A Qualitative Study

Objectives: To understand the impact of physicians and patients religious/spiritual orientation on discussions of spiritual issues. Methods: We performed semi-structured interviews of 10 Missouri family physicians and 10 patients of these physicians, selecting subjects nonrandomly to represent a range of demographic factors, practice types, and chronic or terminal illness. We coded and evaluated transcribed interviews for themes. Results: Respondents expressed that similar belief systems facilitate patient–physician spiritual interactions and bring confidence to their relationships. Those holding dissimilar faiths noted limited ability to address spiritual questions directly. They cited significant barriers to spiritual interaction but considered that ecumenism, use of patient-centered care, and negotiation skills lessen these barriers. Conclusions: Our respondents view spirituality similarly to other aspects of the physician–patient relationship involving differing viewpoints. Where discordance exists, cross-cultural, patient-centered, diplomatic approaches facilitate spiritual discussions.     

On the existence and uniqueness of JML estimates for the partial credit model

A necessary and sufficient condition is given in this paper for the existence and uniqueness of the maximum likelihood (the so-called joint maximum likelihood) estimate of the parameters of the Partial Credit Model. This condition is stated in terms of a structural property of the pattern of the data matrix that can be easily verified on the basis of a simple iterative procedure. The result is proved by using an argument of Haberman (1977). The author wishes to thank the Editor and the anonymous reviewers for their comments that helped to substantially improve the final version of this paper. This research was supported in part by a MURST grant (ex 60%).     

Perceptions of Dating Violence Following a Sexualor Nonsexual Betrayal of Trust: Effects of Gender, Sexism, Acceptance of Rape Myths, and Vengeance Motivation

College womens (N = 220) and mens (N = 208) perceptions of violence following a betrayal by a romantic partner were studied in an independent groups design that varied gender of the participant, type of betrayal (sexual or nonsexual), and gender of the betrayed individual. Participants read one of four brief vignettes in which the betrayed person slapped his/her partner and made his/her lip bleed. Justification of this action was rated on 10 items. Factor analysis of these items indicated the presence of three factors for men and four for women. Both men and women indicated that hitting the partner, getting even, and being angry were more justifiable following a sexual betrayal. The hitting of a male partner by a betrayed woman was perceived as more justified than the hitting of a female partner by a betrayed man. In absolute terms, hitting and getting even by both women and men were generally viewed as unjustifiable, whereas being angry was viewed as justifiable. For both women and men, scores on the Vengeance Scale (Stuckless & Goranson, 1992) and Rape Myth Acceptance Scale (Lonsway & Fitzgerald, 1995) were related to getting even. For men, the Hostile Sexism Scale (Glick & Fiske, 2001) was related to getting even or being angry and breaking up. Results indicated that perceptions of reactions to betrayal are related to type of betrayal and to the dispositional characteristics of the perceiver.     

Bilateral Art: Integrating Art Therapy,Family Therapy,and Neuroscience

This paper describes the systemic use of a neurologically-based art therapy modality—bilateral art—that engages both dominant and non-dominant hands in the process of creating images in response to opposing cognitions or feelings. It describes both neuroscience and family therapy perspectives that argue for the use of bilateral art. A specific protocol for bilateral art therapy is provided along with a case study demonstrating integration of the protocol into the systemic treatment of a young family. Carole M. McNamee, PhD, is Research Professor and Clinical Associate, Director of the Arts in Healthcare Project, The Family Therapy Center, Department of Human Development, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061 (cmcnamee@vt.edu).     

Indian Women’s Experience of a Narrative Intervention Using Art And Writing*

International and minority populations tend to underutilize mental health services, including marriage and family therapy. Models of marriage and family therapy developed in the West may reflect Western values and norms inappropriate for diverse cultural contexts. This article presents an exploratory, qualitative study of a narrative therapy approach with Asian Indian women. This study adds to the small body of narrative-based empirical studies, and has a unique focus on intercultural applications and the experience of participants. Participant experience was examined along four phenomenological dimensions. Findings indicate the suitability of narrative interventions and nontraditional treatment delivery for this population.*This research was presented in 2004 at the annual conference of the American Association for Marriage and Family Therapy.     

Communication flow and change theory within a family therapy supervision model

This article portrays a model of family therapy clinical supervision using change theory that is most appropriate for use with the videotape, audiotape, case presentation and debriefing from the live session. The most powerful tool during this process is that of communication and assessment of change theorys tools of confidence and conviction. The concepts presented are meant to add an additional dimension to family therapy supervision in cooperation of other theories, not as an end in themselves.Special thanks to Ms. Geri Koncilja of the Informational Technology Center at Colorado State University, Pueblo for illustration and graphic assistance.     

Effects of Intimate Partner Violence on Low-Income Women’s Health and Employment

Rates of both intimate partner violence and poor health are high among low-income women This paper examines relationships among abuse, health, and employment stability using data from a 3-year study of over 1000 female welfare recipients in Illinois. Results demonstrate the importance of accounting for both recency and chronicity of intimate partner violence and understanding the mediational role of health in the relationship between intimate partner violence and employment. Chronic intimate partner violence is associated with poor health, whereas recent intimate partner violence is associated with unstable employment. Mediations analyses suggest that health does not mediate the effects of abuse on employment stability over a 3-year period.     

Domestic Violence and Women’s Employment: Fixed Effects Models of Three Waves of Women’s Employment Study Data

Domestic violence can interfere with women’s ability to work, and may result in loss of welfare benefits and poorer economic outcomes. Previous studies showing no effect of domestic violence on employment could be a result of the failure to control for some individual characteristics; therefore we use fixed-effects models with three waves of Women’s Employment Study (WES) data to control for unobservable time-invariant individual-specific characteristics. Included in our analyses were 598 women, from an urban county in Michigan who were on the welfare rolls in February of 1997, all of whom completed 3 waves of interviews. Our fixed effects regression results show that domestic violence significantly reduced the annual work hours of a respondent. Mental and physical health problems do not completely mediate this relationship. Our results support efforts to address domestic violence within the welfare system.