Family, Life Course, and Society Commons^™

Widowhood And The End Of Spousal Caregiving: Wear And Tear Or Relief?, Jennifer Reid Keene, Anastasia H. Prokos

Sociology Faculty Research

This paper analyses the impact of spousal care-giving on survivors’ depressive symptoms six months into widowhood, and examines the applicability of a ‘ relief model’ of spousal adjustment during bereavement. We examine several aspects of the care-giving situation, including care-giver stress, care-giving demands, and type and duration of care and how these affect survivors’ depressive symptomatology. The sample is drawn from two waves of the Changing Lives of Older Couples (CLOC) survey, which was conducted in the United States in the Detroit Metropolitan Area, Michigan. The first wave of data was collected from couples and the second from the surviving …

Focal Cerebral Ischemia In The Tnfalpha-Transgenic Rat, L. Creed Pettigrew, Mark S. Kindy, Stephen W. Scheff, Joe E. Springer, Richard J. Kryscio, Yizhao Li, David S. Grass

Sanders-Brown Center on Aging Faculty Publications

BACKGROUND: To determine if chronic elevation of the inflammatory cytokine, tumor necrosis factor-alpha (TNFalpha), will affect infarct volume or cortical perfusion after focal cerebral ischemia.

METHODS: Transgenic (TNFalpha-Tg) rats overexpressing the murine TNFalpha gene in brain were prepared by injection of mouse DNA into rat oocytes. Brain levels of TNFalpha mRNA and protein were measured and compared between TNFalpha-Tg and non-transgenic (non-Tg) littermates. Mean infarct volume was calculated 24 hours or 7 days after one hour of reversible middle cerebral artery occlusion (MCAO). Cortical perfusion was monitored by laser-Doppler flowmetry (LDF) during MCAO. Cortical vascular density was quantified by stereology. …

The Percentage Of Beds Designated For Medicaid In American Nursing Homes And Nurse Staffing Ratios, Christopher Donoghue

Department of Sociology Faculty Scholarship and Creative Works

Previous analyses of the inverse relationship between a nursing home's Medicaid census and its quality of care have been based on samples limited to specific geographic regions, for-profit entities, or only skilled care facilities. The present study uses national-level data from the 1999 National Nursing Home Survey to examine the association between the proportion of beds designated for Medicaid residents and nurse staffing ratios. The results indicate that homes which designate a higher proportion of their beds for Medicaid recipients maintain lower ratios of registered nurses and nurse's aides to residents, even when key facility characteristics are controlled. It was …

Living With Alzheimer’S Disease: A Study Of Adult Day Health Services In Massachusetts, Nina M. Silverstein, Cathy M. Wong, Kristen E. Brueck

Gerontology Institute Publications

The role of adult day health care (ADHC) is gaining increased attention as the nation prepares for the large cohort of baby boomers entering their later years. Many boomers are aging with physical and cognitive impairments, including Alzheimer's disease and related dementias. Projections indicate that Massachusetts, along with the nation as a whole, is experiencing an increasing rate of older persons as baby boomers enter late-life. The Commonwealth can expect that persons with Alzheimer's disease and their care partners will need community-based services that are specifically designed for adults with cognitive impairments. However, a report by the Robert Wood Johnson …

Exploiting A Research Underclass In Phase 1 Clinical Trials, Carl Elliott, Roberto Abadie

Department of Sociology: Faculty Publications

In November 1996, the Wall Street Journal reported that Eli Lilly was paying homeless alcoholics from a local shelter to participate in safety testing of new drugs at its trial site in Indianapolis.1 “These individuals want to help society,” asserted Lilly’s director of clinical pharmacology. The subjects, however, said they took part for easy money and free room and board. Although Lilly reportedly offered the lowest per diem in the business, it managed to attract poor subjects from all over the country.1 The medical director of the local Homeless Initiative Program said Lilly had created a “shadow economy” of paid …

Parental Influences On Adolescent Girl's Goal Orientations, Perceived Competence, Sport Friendship Quality, And Enjoyment, Carla L. Paiffy, Jeffrey J. Martin

Kinesiology, Health and Sport Studies

The purpose of the present study was to examine the relationships among critical sport psychosocial perceptions of fathers (N=84), mothers (N=84), and daughters (N=84) in the same family (N=252). Athlete participants were young female soccer players ranging in age from 9 to 14 years. A canonical correlation analysis revealed a significant overall multivariate relationship (Wilks's λ = .485, p<.0001) and one significant function emerged (Rc = .64). The loadings suggested that athlete's perceptions of both mother and father created task involving and worry conducive climates all contributed to the multivariate relationship, predicting athlete's perceived competence, sport friendship …

To The Bitter End: Disparities In End-Of-Life Care, Alberto Coustasse, Theresa Quiroz, Sue G. Lurie

Management Faculty Research

Although technological advancements have provided the means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient, bioethical, legal, and moral concerns related to disparities in care still arise in the United States. These concerns call into question the necessity to continue life-sustaining or palliative care treatments when patients and/or families are faced with end-of-life decisions. This study will focus on various historical, clinical cultural, and ethical issues that have placed this dilemma into a controversial public spectrum, by using case studies retrieved from referenced literature, which illustrate disparities …

Obesity: A Lesson From The Venus Of Willendorf, Donald E. Greydanus, Dilip R. Patel, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

No abstract provided.

Evaluation Of The Long-Term Impact Of The Tostan Programme On The Abandonment Of Fgm/C And Early Marriage: Results From A Qualitative Study In Senegal, Nafissatou J. Diop, Amadou Moreau, Helene Benga

Reproductive Health

In 1998–99, a village empowerment program was implemented in the Thiès/Fatick and Kolda regions of Senegal by the nongovernmental organization Tostan, to mobilize communities to hold public declarations in support of abandoning harmful traditional practices, including female genital mutilation/cutting (FGM/C) and child marriage. The information presented in this report indicates that many did end the practices following a public declaration, however, the lack of follow-up in the field and the absence of support mechanisms pose a large obstacle. Nevertheless, the program achieved significant results: knowledge of life skills resulting in positive changes and a shift in the perception of FGM/C …

From Pilot To Program: Scaling Up The Kenya Adolescent Reproductive Health Project, Humphres Evelia, Japheth Nyambane, Harriet Birungi, Ian Askew, Rikka Trangsrud, Eva Muthuuri, Irene Chaami, Agnes Odawa, Lucy Musyoka, Susan Mutungi, Margaret Githuiya, Joan Omuruli

Reproductive Health

The Population Council’s Frontiers in Reproductive Health Program and the Program for Appropriate Technology in Heath collaborated with three Government of Kenya ministries—Education; Health; and Gender, Sports, Culture and Social Services—to design and implement the Kenya Adolescent Reproductive Health Project with the goals of: improving knowledge about reproductive health and encouraging a responsible and healthy attitude toward sexuality among adolescents, delaying the onset of sexual activity among younger adolescents, and decreasing risky behaviors among sexually active adolescents. Key findings from the pilot project showed that the three ministries could successfully implement these interventions with high participation among parents and youth. …

Using Systematic Screening To Integrate Health Services In India And Senegal: Pilot Study Versus Scale-Up Results, James R. Foreit

Reproductive Health

This study examines the effectiveness of using systematic screening to integrate health services in India and Senegal. First, a pilot study of relatively small-scale experiments was undertaken to determine if systematic screening for unmet needs for health services could increase the number of preventive care services clients receive at healthcare visits. FRONTIERS then participated in the scale-up to test the effect of different supervision and training strategies on the frequency of provider screening. Results show that systematic screening may have the potential to produce important increases in the number of services provided in many developing country settings at the pilot …

Sexual And Gender Based Violence In Africa: Literature Review, Population Council

Reproductive Health

This report provides details of a literature review that is intended to inform partners in the Population Council–coordinated regional network that aims to develop a multisectoral and comprehensive response to sexual and gender-based violence (SGBV) in Eastern, Central, and Southern Africa. The first section defines the terminology used throughout the review, and discusses the prevalence and consequences of SGBV, considers the implications of the disproportionate programmatic focus on adult women survivors, and explores approaches to managing child and male survivors of sexual violence. The second section presents regional policies and programming relating to the medical and psychosocial management of survivors. …

Empowering Communities To Make Pregnancy Safer: An Intervention In Rural Andhra Pradesh, Dipa Sinha

Reproductive Health

Recognizing that multiple factors are responsible for adverse pregnancy-related outcomes, a community-based intervention was implemented in Mominpet, in Andhra Pradesh, India in collaboration with the M.V. Foundation, a nongovernmental organization. The intervention focused on improving maternal health outcomes by raising awareness and building family and community support for pregnant women; involving pregnant women’s families, notably their husbands, in pregnancy-related care; and supporting pregnant women to access health services. This report describes the experience and outcomes of the intervention. In particular, it explores the extent to which the intervention was effective in increasing community support for safe motherhood on the one …

L’Introduction De L’Identification Systématique Pour Réduire Les Besoins Non Satisfaits En Santé : Manuel Du Manager, Ricardo Vernon, James R. Foreit, Emma Ottolenghi

Reproductive Health

Ce manuel est conçu pour aider les décideurs, les gestionnaires, les superviseurs et les prestataires de programmes à introduire le dépistage systématique dans leurs services de santé. Le dépistage systématique peut améliorer la santé des femmes en répondant à de multiples besoins non satisfaits en matière de services de santé reproductive et autres. Ce manuel fournit : les activités nécessaires à la mise en œuvre du dépistage systématique ; comment sélectionner les installations, les services à dépister et qui sera dépisté ; l'élaboration, l'adaptation et le prétest systématiques d'une liste de contrôle de dépistage ; des conseils pour les agents …

Senegal: Education And Public Declarations Contribute To Tostan's Success, Population Council

Reproductive Health

In 1998, the nongovernmental organization Tostan implemented a village empowerment program in southern and western Senegal to help communities, especially women, improve living and health conditions in their villages, and to mobilize villages to hold public declarations supporting abandonment of harmful practices, particularly female genital mutilation/cutting (FGM/C) and child marriage. The program included modules on hygiene, literacy and numeracy, human rights, and children’s and women’s health. The Tostan approach has since been implemented more broadly in Senegal and in Burkina Faso, Guinea, and Sudan. In 2005–06, FRONTIERS evaluated the long-term impact of the program, focusing on the abandonment of FGM/C …

Kenya: Training Can Enhance Providers' Management Of Fgm/C And Willingness To Advocate Against The Practice, Population Council

Reproductive Health

In 2004, FRONTIERS collaborated with UNICEF on a study of female genital mutilation/cutting (FGM/C) in Kenya’s Somali community and on ways of managing maternal care for cut women. The study showed that the health-care system in North Eastern Province, where many Somalis live, is ill prepared to deal with women who have been cut, particularly infibulated women who are pregnant or delivering. The study recommended improving providers’ ability to counsel and treat pregnant cut women as part of an overall improvement of maternal care, and strengthening providers’ role as behavior change agents within communities. In 2005, FRONTIERS launched an intervention …

Dominican Republic, Haiti, Nicaragua: Promoting Family Planning During The Postpartum Period Can Increase Contraceptive Acceptance, Population Council

Reproductive Health

The World Health Organization recommends that women receive information on family planning (FP) during antenatal care (ANC), immediately after birth, and during postpartum and well-baby care. However, few studies have assessed the effect of information during each of these stages on women’s use of contraceptive methods. Data collected by FRONTIERS in the Dominican Republic, Haiti, and Nicaragua have been analyzed to answer this question. Use of maternal care services, exposure to FP information, and use of postpartum contraception varies among countries. All women interviewed in the Dominican Republic attended ANC services and delivered in a facility; ANC use and institutional …

Africa Regional Sexual And Gender-Based Violence Network Consultation: Technical Exchange And Planning Meeting, Population Council

Reproductive Health

In March 2008, the Population Council brought together members of the Africa Regional Sexual and Gender Based Violence (SGBV) Network for a South-South technical exchange meeting. The objectives were to identify best practices from existing programs, provide an evidence base for new programming, and develop mechanisms for South-South technical assistance. As detailed in this report, discussions covered the medical, legal, and psychosocial issues associated with SGBV prevention and response activities. Participants identified the following: Protocols and guidance documents are essential for ensuring comprehensive, quality response at all levels. Enabling access and utilization of the full range of medical services remains …

Assessing Routine Health Information System In Selected Paiman Districts By Using Lot Quality Assurance Sampling (Lqas) Technique, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to the hospital. PAIMAN is compiling data from three data sources and making efforts to improve the functioning of these Health Information Systems (HISs) for efficient management of health services at the district level through generation of quality data and their …

Exploring Positive Women's Lives In Namakkal District, India, P. Kousalya, Deepika Ganju

Reproductive Health

This report describes an initiative that was undertaken to document the experiences of HIV-positive ever-married women in Namakkal district, Tamil Nadu, India. The initiative sought to explore the circumstances in which women learned about their HIV status; their feelings on finding out they were HIV-positive; the nature of husband–wife relationships prior to and following disclosure of women’s HIV status; the extent of support or discrimination that women experienced from family members, friends, and neighbors; treatment-seeking behaviors; and women’s perspectives about ways in which the multiple needs of HIV-infected women can be met. Drawing on the testimonies of these women gathered …

Meeting The Family Planning Needs Of Postpartum Women, Ricardo Vernon

Reproductive Health

The first days, weeks, and months after a delivery represent a period of substantial information and service needs for both mother and child, including treatment of hemorrhage and infections, breastfeeding information and support, nutritional complements and micronutrients, immunizations for children and mothers, counseling for managing intimate partner violence and depression, and, most importantly, contraception. In areas of high HIV prevalence, contraceptives and antiretroviral therapy are especially critical elements of postpartum care. Yet despite its strategic importance, few organizations have made it a priority to address women's reproductive health and fertility needs during the year following delivery. The situation is compounded …

Dominican Republic, Haiti, Nicaragua: Women Living With Hiv Have Unmet Family Planning Needs, Population Council

Reproductive Health

Women living with HIV in the Dominican Republic, Haiti, and Nicaragua are marginalized in many ways, including their access to family planning (FP) services. Making FP services accessible to persons living with HIV (PLWH) is one of four key strategies that WHO promotes in its comprehensive approach to prevent HIV infections in infants and young children. This strategy also increases the coverage and quality of FP services among a population commonly underserved and at high risk of unplanned pregnancy. Expanded access to antiretroviral therapy in many developing countries has improved the life expectancies and health of many PLWH who are …

Profile Of Abortion Seekers In Ghana And Their Decision-Making Processes, Philomena Nyarko, Cletus Adohinzin, Saumya Ramarao, Placide Tapsoba, Ayorinde Ajayi

Reproductive Health

In 2006, a consortium of agencies, including the Population Council, came together to provide technical and financial support to the Government of Ghana in the rollout of comprehensive abortion care (CAC) services. The consortium collaborated with the government in expanding women’s access to modern family planning and CAC. The consortium’s program, Reducing Maternal Mortality and Morbidity (R3M), aims to reduce unwanted pregnancy and severe complications and deaths caused by unsafe abortion. The formative research in this report was undertaken to provide a profile of beneficiaries, their needs for information and services, their decision-making process in seeking care, and the quality …

Fertility Transitions In Developing Countries: Progress Or Stagnation?, John Bongaarts

Poverty, Gender, and Youth

Over the past quarter century fertility has declined rapidly in many developing countries. Projections typically assume that this trend will continue until the replacement level is reached. However, recent evidence suggests that ongoing fertility declines may have slowed or stalled in a number of countries in transition. This Population Council study examines the pace of fertility change in developing countries that have multiple DHS surveys to determine whether ongoing transitions are decelerating or stalling. The main findings are that in sub-Saharan African countries, the average pace of decline in fertility is lower around 2000 than in the mid-1990s, and more …

Analysis Of The Evolution Of The Practice Of Female Genital Mutilation/Cutting In Burkina Faso, Nafissatou J. Diop, Zakari Congo, Aina Ouedraogo, Alphosine Sawadogo, Lydia Saloucou, Ida Tamini

Reproductive Health

This study was undertaken as a collaboration between the Population Council’s Frontiers in Reproductive Health program and the Comité National de Lutte contre la Pratique de l’Excision (CNLPE) within the Ministry of Social Action and National Solidarity in Burkina Faso. The creation of a favorable environment for the campaign against excision in Burkina Faso has facilitated various anti-cutting activities over the past two decades and enabled the achievement of gains, both in terms of awareness and behavior change. However some of the strategies need further readjustment: among the reasons why excision still continues in Burkina Faso is a certain view …

Bolivia: A Gender Focus In Service Delivery Improves Quality Of Care, Population Council

Reproductive Health

A program to operationalize and institutionalize a gender perspective in reproductive health services in Bolivia resulted in a significant reduc­tion in unmet need for contraception, increased client satisfaction, and improved communication between partners. Bolivia’s Integral Health Coordination Program (PROCOSI) encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their RH programs. In 2005, FRONTIERS collaborated with PRO­COSI to test the feasibility and costs of a sys­tem for certifying that its member organizations provided gender-sensitive RH services. The two-year project followed a 2000 intervention to incorporate gender perspectives in PROCOSI clinics that led …

Family Planning And Comprehensive Abortion Care Handbook For Medical Students And House Officers, Population Council

Reproductive Health

The persistently high maternal mortality and morbidity in Ghana is partly due to high rates of unwanted fertility, unsafe abortion, and relatively low use of modern contraception. In 2006, a consortium of agencies, including the Population Council, initiated the Reducing Maternal Mortality and Morbidity program. The program provides financial and technical resources that will enable the government to significantly expand women's access to modern family planning, contraception, and comprehensive abortion care (CAC) to reduce maternal mortality in Ghana. This handbook on FP and CAC was developed as part of the program. It updates a previous document produced more than ten …

Migration/Mobility And Vulnerability To Hiv Among Male Migrant Workers: Tamil Nadu 2007-08, Anjaneyalu Subbiah, S. Ramachandran, A.K. Ravi Shankar, Niranjan Saggurti, Ravi K. Verma, Anrudh K. Jain, Saumya Ramarao, Suvakanta N. Swain, Ajay Kumar Singh

HIV and AIDS

The present study was undertaken by the Population Council in partnership with Annamali University, Tamil Nadu, India to study the broad patterns and motivating forces driving migrant men’s mobility and the contexts that determine and influence their engaging in high-risk activities that increase their vulnerability to HIV. The results indicate large interdistrict movements of working men in Tamil Nadu with a little variation across districts and greater mobility among younger men. Research results suggest that further examination of the contract system under which many of the migratory laborers work is a potential focus for program intervention. Places of origin offer …

Involving Young People In The Care And Support Of People Living With Hiv In Zambia: An Evaluation Of Program Sustainability, Eka Esu-Williams, Catherine Searle, Anderson Zulu

HIV and AIDS

In 2005, approximately 17 percent of the population of reproductive age in Zambia was infected with HIV and nearly 710,000 under the age of 18 were orphans. As the needs of people living with HIV (PLHIV) and orphans and vulnerable children (OVC) escalate, communities are seeking new ways of helping those affected by the disease. A Horizons intervention study conducted in northern Zambia from 2000–02 found that youth could be trained to help meet the care and support needs of PLHIV and their families, including OVC. Study participants belonged to anti-AIDS clubs that taught about HIV and how to prevent …

Institutionalization Of Quality Assurance Within District Health Management: Experiences From Maharashtra And Karnataka, M.E. Khan, Anurag Mishra, Vivek Sharma, Jaleel Ahmad, Jose Joseph, Venkatesh Srinivasan, K.M. Sathyanarayana, Viji Vargees, K.D. Maiti, Rashmi Sharma

Reproductive Health

The Population Council, with financial support from UNFPA, provided technical assistance to the states of Maharashtra and Karnataka, India in implementing a quality assurance (QA) program and helped its institutionalization in the district level of health management. An analysis of all the facilities covered as of December 2007 revealed substantial gaps in the infrastructure and human resources available to provide good-quality services, as well as adherence to standards for providing the services. To build the capacity to undertake QA visits, the Population Council and state authorities organized a series of events to orient and train state and district officials, facility-level …