Jeanne Parr Lemkau

The importance of physician encouragement in breast cancer screening of older women

METHODS The relationship between physician encouragement and breast cancer screening is examined with a population-based survey of 630 women between the ages of 45 and 75. Although the women interviewed were selected on the basis of their noncompliance with mammography guidelines, nearly half had previously had at least one mammogram. RESULTS Women reported having received more physician encouragement of breast self-examination than of mammography. Older women reported less encouragement of both screening modalities than younger women. Multivariate analyses revealed physician encouragement to be more strongly associated with screening mammography than with health status, health care utilization, attitudes, and sociodemographic characteristics: those who reported having received physician encouragement were nearly four times more likely to have ever had screening mammography. CONCLUSIONS These and related findings are used to highlight the critical importance of physician behavior in the secondary prevention of breast cancer in older women and to identify types of patients whose needs for screening are most likely to be overlooked by physicians.

Cultural Issues in the Primary Care of South Asians

One of the fastest growing immigrant groups in the United States is from the Indian subcontinent of South Asia. Included in this group are people from India, Sri Lanka, Bangladesh, and Pakistan. Although there is considerable heterogeneity within and between the populations of these countries, cultural similarities contribute to common challenges when South Asian immigrants are seen in primary care settings in the United States. This article describes aspects of the South Asian culture and of the acculturation process relevant to establishing rapport and providing competent biopsychosocial care to individuals and families from this region. We discuss the differing needs of recent immigrants, second-generation Americans from South Asia, and individuals temporarily in the United States for study or employment. We discuss linguistic and interpersonal style concerns in regard to the relationship between health care professionals and immigrant patients and use case material to illustrate cultural issues. We conclude with suggestions for culturally sensitive health care of South Asians.

Men in Female-Dominated Professions: Distinguishing Personality and Background Features

Abstract Personality and background features of men in female-dominated professions were assessed by comparing survey data on 54 men employed in atypical professions ( A ′s) with 63 men employed in sex-typical fields ( S ′s). Subjects were American born, college-educated males, under 50 years of age, employed in fields with over 75% male or female participation, and recruited in Atlanta in 1978. Subjects completed a biographical questionnaire, the Cattell 16 PF, and the Bem Sex Role Inventory under three instructional sets. In comparison with S ′s the A ′s showed lower adherence to traditional sex-role expectations on the Bem Sex Role Inventory, in the allotment of sex-typed household responsibilities, and in their greater “tender-minded” emotional sensitivity on the Cattell 16 PF. In terms of their personal histories, A ′s more frequently reported having had employed mothers, having had distant relationships with their fathers, and having been positively influenced in their career choices by women. A ′s more frequently experienced a death of a parent or sibling, or parental divorce or separation, and frequently mentioned such stresses as sensitizing them to their nurturant and emotional capabilities. There was also evidence that upward-mobility strivings may have contributed to atypical career choice, with A ′s more frequently being members of racial minorities and/or of lower socioeconomic background. As expected, in contrast to S ′s, A ′s shared personality and socialization factors indicative of lower sex-typing, thus confirming the psychological significance of the sex composition of ones occupation for men as was confirmed earlier for women.

Family perspectives on communication with healthcare providers during end-of-life cancer care

PURPOSE/OBJECTIVES To assess healthcare provider communication about end-of-life (EOL) and hospice care with patients with terminal cancer and their families, from the perspective of the family members. DESIGN Exploratory, qualitative study using focus group discussion. SETTING University of Maryland Greenebaum Cancer Center. SAMPLE 24 spouses and first-degree relatives of deceased patients with cancer who had been treated at the cancer center from 2000-2002. METHODS Family members participated in one of two focus group discussions and completed a short questionnaire regarding their sociodemographic characteristics and the type of EOL care their deceased relatives had received. Quantitative data were analyzed using descriptive statistics. Qualitative data were audiotaped and analyzed by comparing, contrasting, and summarizing content themes from the focus groups using NUD IST 5(N5) software. MAIN RESEARCH VARIABLES Family perceptions of communication with the healthcare team in EOL cancer care. FINDINGS Participants associated the information, content, style, language, and timing of communication about EOL and hospice care from healthcare professionals with patient age, attitudes, and compliance with medical decisions. Informed decisions about EOL care by patients and their family members, including the use of hospice services, appeared to be compromised by these types of communication biases. CONCLUSIONS Satisfaction with EOL care was associated with the perceived quality of communication among patients, family members, and the healthcare team. IMPLICATIONS FOR NURSING Study findings highlight the importance of training healthcare professionals in the content, timing, and potential biases associated with information delivery to facilitate informed decisions about EOL and hospice care to dying patients and their families.

EMOTIONAL SEQUELAE OF ABORTION Implications for Clinical Practice

The literature is summarized on normative reactions to abortion and factors that increase risk of negative emotional sequelae. Four areas of inquiry for identifying psychotherapeutic issues in regard to abortion are elaborated, including: (a) characteristics of the woman prior to and at the time of the abortion, (b) the nature of social support and the cultural milieu around the abortion, (c) characteristics of the medical environment and abortion procedure, and (d) events subsequent to the abortion which may have aroused post-decisional conflict. The implications of the research literature for psychotherapeutic treatment of women who have had abortions are discussed.

Personality profiles of women in traditional and nontraditional occupations

Abstract Realizing the need for a comprehensive comparison of personality traits between noncollege-degreed women in female typical occupations (FTO) and male typical occupations (MTO), we examined the personality profiles of 171 women (131 women in four FTO and 40 women in two MTO) using the California Psychological Inventory (CPI, Gough 1975, Manual for the California Psychological Inventory. Palo Alto, CA: Consulting Press). The two groups were equally educated and were within the same age bracket. Although the personality configurations of women in the two groups were generally similar, a stepwise discriminant analysis showed that five scales differentiated between the personality of women in FTO and MTO. These were Femininity (Fe), Communality (Cm), Self-control (Sc), Capacity for status (Cs), and Dominance (Do). Profile similarities and differences were used to describe women in these noncollege-degreed occupations and were related to the literature on personality and career management. Relevance of these findings to future research focusing on within-gender differences and cognitive perspectives was discussed.

Fibromyalgia: A Feminist Biopsychosocial Perspective

Abstract Fibromyalgia (FM) is a syndrome predominantly experienced by women and characterized by pain, fatigue, sleep disturbance, and multiple tender points at distinct locations on the body. Because of its prevalence and the common comorbidity of FM with depression and other conditions that prompt sufferers to seek psychological care, it is incumbent upon psychologists to be familiar with the syndrome, competent to provide assistance to afflicted individuals, and aware of the impact of gender politics on fibromyalgia sufferers. We present an overview of the diagnosis and treatment of fibromyalgia, a brief summary of etiological possibilities, and a discussion of the experience of illness among affected individuals. We conclude by exploring the social construction of the syndrome from a feminist perspective.

The declining job satisfaction of white-collar women in sex-segregated and mixed-sex occupations

Abstract The declining job satisfaction of women white-collar workers reported by J. Veroff, E. Douvan, and R. A. Kulka (1981, The Inner American: A self-portrait from 1957 to 1976 , New York, Basic Books) is explored through secondary analyses of their data from two national cross-sectional surveys conducted in 1957 and 1976. Analyses were done using data from 258 women in 1957 and 372 women in 1976 in white-collar jobs. Multivariate contingency table analyses were used first to explore the separate effects of type of white-collar employment, whether or not the job was sex segregated, age, birth cohort, and education on job satisfaction declines. The decline in job satisfaction was found to be greater for women in sex-segregated occupations that in mixed-sex ones. In addition, while all white-collar women express increased dissatisfaction with ego-involving aspects of work, those in sex-segregated fields showed the greatest increases in job dissatisfactions in affiliative and achievement spheres. Neither type of white-collar employment nor birth cohort related to differential job satisfaction declines though age and education changes did. The final multivariate analysis demonstrated that the changing age and educational characteristics of job holders in sex-segregated fields accounted for the greater job satisfaction declines for these women, and that sex segregation did not appear to affect job satisfaction beyond changes related to these demographic factors.

Turning Roadblocks into Stepping Stones: Teaching Psychology to Physicians

Under the label of behavioral science, psychological content has become integrated into the didactic and clinical teaching curricula of many medical schools and residency training programs. Psychology faculty frequently face the difficult task of making their material relevant to physicians. Ten suggestions that address the content and process of teaching psychology to medical students, residents, and faculty are discussed.

Psychological Distress of Cuban Americans Affected by Restrictive U.S. Travel Policies

ABSTRACT We describe the mental health consequences of United States travel policies affecting Cuban Americans (CAs) with relatives in Cuba and discuss these policies in the context of U.S. domestic politics and the Bush administrations desire for regime change in Cuba. Policies put into effect in 2004 restrict CAs from visiting relatives in Cuba more than once every 3 years, narrowly define family whom CAs can legally visit, and limit the assistance they can provide their Cuban relatives. We share case reports based on qualitative interviews with 53 Cuban Americans that illustrate travel-related psychological distress (TRPD) experienced by CAs in response to the restrictions. We note the difficulties CAs experience in coping with TRPD and the need for political and mental health interventions to address this condition. TRPD is directly related to the governments violation of the human and constitutional rights of CAs to travel freely. It is the responsibility of the state to restore those rights. Human services professionals should oppose TRPD as antithetical to family well-being.