Constructions of masculinity and their influence on men's well-being: a theory of gender and health

Men in the United States suffer more severe chronic conditions, have higher death rates for all 15 leading causes of death, and die nearly 7 yr younger than women. Health-related beliefs and behaviours are important contributors to these differences. Men in the United States are more likely than women to adopt beliefs and behaviours that increase their risks, and are less likely to engage in behaviours that are linked with health and longevity. In an attempt to explain these differences, this paper proposes a relational theory of men's health from a social constructionist and feminist perspective. It suggests that health-related beliefs and behaviours, like other social practices that women and men engage in, are a means for demonstrating femininities and masculinities. In examining constructions of masculinity and health within a relational context, this theory proposes that health behaviours are used in daily interactions in the social structuring of gender and power. It further proposes that the social practices that undermine men's health are often signifiers of masculinity and instruments that men use in the negotiation of social power and status. This paper explores how factors such as ethnicity, economic status, educational level, sexual orientation and social context influence the kind of masculinity that men construct and contribute to differential health risks among men in the United States. It also examines how masculinity and health are constructed in relation to femininities and to institutional structures, such as the health care system. Finally, it explores how social and institutional structures help to sustain and reproduce men's health risks and the social construction of men as the stronger sex.

Methods for integrating moderation and mediation: A general analytical framework using moderated path analysis

Studies that combine moderation and mediation are prevalent in basic and applied psychology research. Typically, these studies are framed in terms of moderated mediation or mediated moderation, both of which involve similar analytical approaches. Unfortunately, these approaches have important shortcomings that conceal the nature of the moderated and the mediated effects under investigation. This article presents a general analytical framework for combining moderation and mediation that integrates moderated regression analysis and path analysis. This framework clarifies how moderator variables influence the paths that constitute the direct, indirect, and total effects of mediated models. The authors empirically illustrate this framework and give step-by-step instructions for estimation and interpretation. They summarize the advantages of their framework over current approaches, explain how it subsumes moderated mediation and mediated moderation, and describe how it can accommodate additional moderator and mediator variables, curvilinear relationships, and structural equation models with latent variables.

Bias in cross-sectional analyses of longitudinal mediation

Most empirical tests of mediation utilize cross-sectional data despite the fact that mediation consists of causal processes that unfold over time. The authors considered the possibility that longitudinal mediation might occur under either of two different models of change: (a) an autoregressive model or (b) a random effects model. For both models, the authors demonstrated that cross-sectional approaches to mediation typically generate substantially biased estimates of longitudinal parameters even under the ideal conditions when mediation is complete. In longitudinal models where variable M completely mediates the effect of X on Y, cross-sectional estimates of the direct effect of X on Y, the indirect effect of X on Y through M, and the proportion of the total effect mediated by M are often highly misleading.

An integrative model of shared decision making in medical encounters

OBJECTIVE

Given the fluidity with which the term shared decision making (SDM) is used in teaching, assessment and research, we conducted a focused and systematic review of articles that specifically address SDM to determine the range of conceptual definitions.

METHODS

In April 2005, we ran a Pubmed (Medline) search to identify articles published through 31 December 2003 with the words shared decision making in the title or abstract. The search yielded 681 citations, 342 of which were about SDM in the context of physician-patient encounters and published in English. We read and reviewed the full text of all 342 articles, and got any non-redundant references to SDM, which yielded an additional 76 articles.

RESULTS

Of the 418 articles examined, 161 (38.5%) had a conceptual definition of SDM. We identified 31 separate concepts used to explicate SDM, but only "patient values/preferences" (67.1%) and "options" (50.9%) appeared in more than half the 161 definitions. Relatively few articles explicitly recognized and integrated previous work.

CONCLUSION

Our review reveals that there is no shared definition of SDM. We propose a definition that integrates the extant literature base and outlines essential elements that must be present for patients and providers to engage in the process of SDM.

PRACTICE IMPLICATIONS

The integrative definition of SDM is intended to provide a useful foundation for describing and operationalizing SDM in further research.

Influence of social motives on integrative negotiation: a meta-analytic review and test of two theories

A meta-analysis of 28 studies examined support for the Theory of Cooperation and Competition (M. Deutsch, 1973) and Dual Concern Theory (D. G. Pruitt & J. Z. Rubin, 1986). Effects of social motive (prosocial vs. egoistic) and resistance to yielding (high vs. low vs. unknown) on contenting, problem solving, and joint outcomes were examined. Consistent with Dual Concern Theory, results showed that negotiators were less contentious, engaged in more problem solving, and achieved higher joint outcomes when they had a prosocial rather than egoistic motive, but only when resistance to yielding was high (or unknown) rather than low. The authors also explored the moderating effects of study characteristics and found effects for participation inducement (class exercise, participant pool), for publication status, and for treatment of no-agreement dyads.

Getting evidence into practice: the role and function of facilitation

AIM OF PAPER

This paper presents the findings of a concept analysis of facilitation in relation to successful implementation of evidence into practice.

BACKGROUND

In 1998, we presented a conceptual framework that represented the interplay and interdependence of the many factors influencing the uptake of evidence into practice. One of the three elements of the framework was facilitation, alongside the nature of evidence and context. It was proposed that facilitators had a key role in helping individuals and teams understand what they needed to change and how they needed to change it. As part of the on-going development and refinement of the framework, the elements within it have undergone a concept analysis in order to provide theoretical and conceptual clarity.

METHODS

The concept analysis approach was used as a framework to review critically the research literature and seminal texts in order to establish the conceptual clarity and maturity of facilitation in relation to its role in the implementation of evidence-based practice.

FINDINGS

The concept of facilitation is partially developed and in need of delineation and comparison. Here, the purpose, role and skills and attributes of facilitators are explored in order to try and make distinctions between this role and other change agent roles such as educational outreach workers, academic detailers and opinion leaders.

CONCLUSIONS

We propose that facilitation can be represented as a set of continua, with the purpose of facilitation ranging from a discrete task-focused activity to a more holistic process of enabling individuals, teams and organizations to change. A number of defining characteristics of facilitation are proposed. However, further research to clarify and evaluate different models of facilitation is required.

The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform

IMPORTANCE

The increasing cost of prescription drugs in the United States has become a source of concern for patients, prescribers, payers, and policy makers.

OBJECTIVES

To review the origins and effects of high drug prices in the US market and to consider policy options that could contain the cost of prescription drugs.

EVIDENCE

We reviewed the peer-reviewed medical and health policy literature from January 2005 to July 2016 for articles addressing the sources of drug prices in the United States, the justifications and consequences of high prices, and possible solutions.

FINDINGS

Per capita prescription drug spending in the United States exceeds that in all other countries, largely driven by brand-name drug prices that have been increasing in recent years at rates far beyond the consumer price index. In 2013, per capita spending on prescription drugs was $858 compared with an average of $400 for 19 other industrialized nations. In the United States, prescription medications now comprise an estimated 17% of overall personal health care services. The most important factor that allows manufacturers to set high drug prices is market exclusivity, protected by monopoly rights awarded upon Food and Drug Administration approval and by patents. The availability of generic drugs after this exclusivity period is the main means of reducing prices in the United States, but access to them may be delayed by numerous business and legal strategies. The primary counterweight against excessive pricing during market exclusivity is the negotiating power of the payer, which is currently constrained by several factors, including the requirement that most government drug payment plans cover nearly all products. Another key contributor to drug spending is physician prescribing choices when comparable alternatives are available at different costs. Although prices are often justified by the high cost of drug development, there is no evidence of an association between research and development costs and prices; rather, prescription drugs are priced in the United States primarily on the basis of what the market will bear.

CONCLUSIONS AND RELEVANCE

High drug prices are the result of the approach the United States has taken to granting government-protected monopolies to drug manufacturers, combined with coverage requirements imposed on government-funded drug benefits. The most realistic short-term strategies to address high prices include enforcing more stringent requirements for the award and extension of exclusivity rights; enhancing competition by ensuring timely generic drug availability; providing greater opportunities for meaningful price negotiation by governmental payers; generating more evidence about comparative cost-effectiveness of therapeutic alternatives; and more effectively educating patients, prescribers, payers, and policy makers about these choices.

Long-term neurobehavioural impact of the postnatal environment in rats: manipulations, effects and mediating mechanisms

The major characteristics of the postnatal environment of the rat pup are its mother and littermates. The pup, which is poorly developed at birth, matures rapidly in this environment, and regulates the behaviour and physiology of the dam and littermates, as well as vice versa. The study of the impact of the rat's postnatal environment on its long-term neurobehavioural development is of fundamental importance. In fact, it is one of the major examples--at the interface of the biological, social and medical sciences--of animal models for the study of the interaction between the environment and the genome in both the acute and chronic regulation of the phenotype. Specific experimental manipulations of the rat postnatal environment have been demonstrated to exert robust and marked effects on neurobiological, physiological and behavioural phenotypes in adulthood. In the present review we present some of the major findings, including some original data, and discuss what these existing data can tell us about the long-term neurobehavioural effects of the postnatal environment in rats, the external and internal mechanisms that mediate these effects, and the most appropriate directions for future basic and applied research in this area.

Principles of Clinical Ethics and Their Application to Practice

An overview of ethics and clinical ethics is presented in this review. The 4 main ethical principles, that is beneficence, nonmaleficence, autonomy, and justice, are defined and explained. Informed consent, truth-telling, and confidentiality spring from the principle of autonomy, and each of them is discussed. In patient care situations, not infrequently, there are conflicts between ethical principles (especially between beneficence and autonomy). A four-pronged systematic approach to ethical problem-solving and several illustrative cases of conflicts are presented. Comments following the cases highlight the ethical principles involved and clarify the resolution of these conflicts. A model for patient care, with caring as its central element, that integrates ethical aspects (intertwined with professionalism) with clinical and technical expertise desired of a physician is illustrated.

The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women

OBJECTIVES

This study examined the consequences of having a physically abusive primary partner on the condom use and sexual negotiation practices of young African-American women.

METHODS

Interviews were conducted with 165 sexually active African-American women aged 18 through 29 in San Francisco, Calif.

RESULTS

Women in abusive relationships were less likely than others to use condoms and were more likely to experience verbal abuse, emotional abuse, or threats of physical abuse when they discussed condoms. They were more fearful of asking their partners to use condoms, worried more about acquiring the human immunodeficiency virus (HIV), and felt more isolated than did women not in abusive relationships.

CONCLUSIONS

HIV prevention programs for women should address domestic violence prevention strategies.

The importance of patient preferences in treatment decisions--challenges for doctors

The expectation that patients will become increasingly involved in making treatment decisions poses new challenges for doctors. This article discusses what these are and how doctors might face them

Parental monitoring, negotiated unsupervised time, and parental trust: the role of perceived parenting practices in adolescent health risk behaviors

PURPOSE

To compare two different parenting practices (parental monitoring and negotiated unsupervised time) and perceived parental trust in the reporting of health risk behaviors among adolescents.

METHODS

Data were derived from 692 adolescents in 9th and 10th grades (x = 15.7 years) enrolled in health education classes in six urban high schools. Students completed a self-administered paper-based survey that assessed adolescents' perceptions of the degree to which their parents monitor their whereabouts, are permitted to negotiate unsupervised time with their friends and trust them to make decisions. Using gender-specific multivariate logistic regression analyses, we examined the relative importance of parental monitoring, negotiated unsupervised time with peers, and parental trust in predicting reported sexual activity, sex-related protective actions (e.g., condom use, carrying protection) and substance use (alcohol, tobacco, and marijuana).

RESULTS

For males and females, increased negotiated unsupervised time was strongly associated with increased risk behavior (e.g., sexual activity, alcohol and marijuana use) but also sex-related protective actions. In males, high parental monitoring was associated with less alcohol use and consistent condom use. Parental monitoring had no affect on female behavior. Perceived parental trust served as a protective factor against sexual activity, tobacco, and marijuana use in females, and alcohol use in males.

CONCLUSIONS

Although monitoring is an important practice for parents of older adolescents, managing their behavior through negotiation of unsupervised time may have mixed results leading to increased experimentation with sexuality and substances, but perhaps in a more responsible way. Trust established between an adolescent female and her parents continues to be a strong deterrent for risky behaviors but appears to have little effect on behaviors of adolescent males.

Mediators, Moderators, and Predictors of 1-Year Outcomes Among Children Treated for Early-Onset Conduct Problems: A Latent Growth Curve Analysis

Several child conduct problem interventions have been classified as either efficacious or well established. Nevertheless, much remains to be learned about predictors of treatment response and mechanisms of behavioral change. In this study, the authors combine data from 6 randomized clinical trials and 514 children, ages 3.0-8.5 years, to evaluate moderators, mediators, and predictors of outcome. Among other findings, latent growth curve models of mother-report and observational measures of child externalizing behaviors suggested that marital adjustment, maternal depression, paternal substance abuse, and child comorbid anxiety/depression each moderated treatment response. Moreover, critical, harsh, and ineffective parenting both predicted and mediated outcome, with the most favorable responses observed when parents scored relatively low on each construct at intake yet improved during treatment. Implications for treatment nonresponders are discussed.

An empirical examination of the mechanisms mediating between high-performance work systems and the performance of Japanese organizations

The resource-based view of the firm and social exchange perspectives are invoked to hypothesize linkages among high-performance work systems, collective human capital, the degree of social exchange in an establishment, and establishment performance. The authors argue that high-performance work systems generate a high level of collective human capital and encourage a high degree of social exchange within an organization, and that these are positively related to the organization's overall performance. On the basis of a sample of Japanese establishments, the results provide support for the existence of these mediating mechanisms through which high-performance work systems affect overall establishment performance.

The interpersonal effects of anger and happiness in negotiations

Three experiments investigated the interpersonal effects of anger and happiness in negotiations. In the course of a computer-mediated negotiation, participants received information about the emotional state (anger, happiness, or none) of their opponent. Consistent with a strategic-choice perspective, Experiment 1 showed that participants conceded more to an angry opponent than to a happy one. Experiment 2 showed that this effect was caused by tracking--participants used the emotion information to infer the other's limit, and they adjusted their demands accordingly. However, this effect was absent when the other made large concessions. Experiment 3 examined the interplay between experienced and communicated emotion and showed that angry communications (unlike happy ones) induced fear and thereby mitigated the effect of the opponent's experienced emotion. These results suggest that negotiators are especially influenced by their opponent's emotions when they are motivated and able to consider them.

Sexual negotiation in the AIDS era: negotiated safety revisited

OBJECTIVE

To test the safety of the 'negotiated safety' strategy-the strategy of dispensing with condoms within HIV-seronegative concordant regular sexual relationships under certain conditions.

METHOD

Data from recently recruited cohort of homosexually active men (Sydney Men and Sexual Health cohort, n = 1037) are used to revisit negotiated safety. The men were surveyed using a structured questionnaire and questions addressing their sexual relationships and practice their own and their regular partner's serostatus, agreements entered into by the men concerning sexual practice within and outside their regular relationship, and contextual and demographic variables.

RESULTS

The findings indicate that a significant number of men used negotiated safety as an HIV prevention strategy. In the 6 months prior to interview, of the 181 men in seroconcordant HIV-negative regular relationships, 62% had engaged in unprotected anal intercourse within their relationship, and 91% (165 men) had not engaged in unprotected anal intercourse outside their relationship. Of these 165 men, 82% had negotiated agreements about sex outside their relationship. The safety of negotiation was dependent not only on seroconcordance but also on the presence of an agreement; 82% of the men who had not engaged in unprotected anal intercourse outside their regular relationship had entered into an agreement with their partner, whereas only 56% of those who had engaged in unprotected anal intercourse had an agreement. The safety of negotiation was also related to the nature of the safety agreement reached between the men and on the acceptability of condoms. Agreements between HIV-negative seroconcordant regular partners prohibiting anal intercourse with casual partners or any form of sex with a casual partner were typically complied with, and men who had such negotiated agreements were at low risk of HIV infection.

CONCLUSIONS

The adoption of the strategy of negotiated safety among men in HIV-seronegative regular relationships may help such men sustain the safety of their sexual practice.

Perceiving interpersonal conflict and reacting to it: the case for agreeableness

Two converging, multimethod studies probed the hypothesis that individual differences in Agreeableness are related to patterns of interpersonal conflict. In Study 1, participants (N = 263) evaluated the efficacy of 11 modes of conflict resolution within the context of 5 different interpersonal relationships. Across all relationships, high- and low-agreeable participants rated negotiation and disengagement tactics as better choices that power assertion tactics. However, low-agreeable participants rated power assertion as a better choice than did high-agreeable participants. In Study 2, participants (N = 124) were assigned partners and were asked to resolve jointly 2 social conflict problems. Partners were videotaped, and observers coded behaviors. Participants also completed ratings of perceived conflict, partner perception, and liking of their partner. Agreeableness differences, sex of participant, and type of dyad partner were related to patterns of interpersonal conflict. Results were discussed in terms of personality and social influences during interpersonal conflict.

A conceptual framework for person-centred practice with older people

This paper presents a conceptual framework for person-centred practice with older people. The research from which the framework was developed was guided by hermeneutic philosophy and integrated processes of conversation analysis and reflective conversation in data collection and analysis. The research findings suggested that nurses need to be able to particularize the person that the patient is, the relationship that exists between them and the patient, and the understandings and expectations implicit in the relationship. From these findings a conceptual framework for person-centred practice was developed. In the framework, person-centredness is premised on the concept of authentic consciousness and is operationalized through five imperfect duties. The factors that enable person-centredness to operate in practice are identified as the patient's values, the nurse's values and the context of the care environment. Considerations for implementing the model in practice are highlighted.

Family centred care: a review of qualitative studies

AIM

To review systematically qualitative studies, which were found during a literature search for a Cochrane systematic review of the use of family centred care in children's hospitals.

BACKGROUND

Family centred care has become a cornerstone of paediatric practice, however, its effectiveness is not known. No single definition exists, rather a list of elements that constitute family centred care. However, it is recognized to involve the parents in care planning for a child in health services. A new definition is presented here.

METHODS

The papers were found in wide range of databases, by hand searching and by contacting the authors where necessary, using terms given in detail in the protocol in the Cochrane Library, in 2004. Qualitative studies could not be used for statistical analysis, but are still important to the review and so are described separately in this paper.

RESULTS

Negotiation between staff and families, perceptions held by both parents and staff roles influenced the delivery of family centred care. A sub-theme of cost of family centred care to families and staffs was discovered and this included both financial and emotional costs.

CONCLUSION

Further research is needed to generate evidence about family centred care in situations arising from modern models of care in which family centred care is thought to be an inherent part, but which leave families with the care of sick children with little or no support.

RELEVANCE TO CLINICAL PRACTICE

Family centred care is said to be used widely in practice. More research is needed to ensure that is it being implemented correctly.

Affective mechanisms linking dysfunctional behavior to performance in work teams: a moderated mediation study

The present study examines the association between dysfunctional team behavior and team performance. Data included measures of teams' dysfunctional behavior and negative affective tone as well as supervisors' ratings of teams' (nonverbal) negative emotional expressivity and performance. Utilizing a field sample of 61 work teams, the authors tested the proposed relationships with robust data analytic techniques. Results were consistent with the hypothesized conceptual scheme, in that negative team affective tone mediated the relationship between dysfunctional team behavior and performance when teams' nonverbal negative expressivity was high but not when nonverbal expressivity was low. On the basis of the findings, the authors conclude that the connection between dysfunctional behavior and performance in team situations is more complex than was previously believed--thereby yielding a pattern of moderated mediation. In sum, the findings demonstrated that team members' collective emotions and emotional processing represent key mechanisms in determining how dysfunctional team behavior is associated with team performance.

Trust in the face of conflict: the role of managerial trustworthy behavior and organizational context

The authors explored the role of attributions in shaping employees' trust in their managers in the context of negative events. The authors examined how 2 forms of managerial trustworthy behavior (open communication and demonstrating concern for employees) and organizational policies relate to attributions, trust in the manager, and organizational citizenship behavior. Participants were 115 credit union employees who responded to a critical incident regarding a disagreement with their managers. As hypothesized, trustworthy behavior was negatively related to attributions of personal responsibility for negative encounters, and this relationship was stronger when human resource policies were perceived as unfair. Managerial trustworthy behavior was also positively related to trust in the manager and organizational citizenship behavior. Personal attributions partially mediated the relationship between trustworthy behavior and trust.

Transfer of communication skills training from workshop to workplace: the impact of clinical supervision

OBJECTIVE

Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process.

METHODS

A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns.

RESULTS

Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues.

CONCLUSIONS

The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.