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A Focus on Resilience: Children during Marital Transition

Resilience is very important in order to establish positive adaptation during marital transition. Divorce and remarriage involve a complex series of changes that can affect all aspects of family relationships. In attempts to recapture normalcy after marital separation, the feelings of hurt and pain, sadness and anger are particularly intense among children and parents. Counselling will provide the basic foundation needed and the ability to face adversity or risks, easing the challenges confronting members of families in transition.  Based on the significant body of research, most children adequately adjust to dramatic changes such as emotional distress, psychological confusion, and relationship strain. The experience of children of divorce eventually meets the criteria of Garmezy’s definition of resilience “the maintenance of competent functioning despite an interfering emotionality” (1991, p. 466).

Discussion

          Longitudinal research on prevention shows that communication problems and destructive marital conflict are among the leading risk factors for future divorce and marital distress. The effects of divorce and marital distress caused by destructive conflict are passed on to spouses and children. According to Stanley et al. (1995), longitudinal studies have found that destructive patterns such as invalidation, withdrawal, pursuit-withdrawal and negative interpretation undermine marital happiness.   The success of marriage is undermined by the active erosion of love, sexual attraction, friendship, trust, and commitment. Over 6 million children of divorce are growing up, and the study of specific mental health issue should be encouraged among current and future public health practitioners. The study will be instrumental in the development of variety of approaches that will deal with both normal and disturbed children, focusing on the immediate and future impact.

Conclusion

          Many children hold inappropriate feelings of responsibility for their parents’ continuing relationship, and misunderstandings about the reasons for divorce. Children’s relationship to nonresidential parents, most commonly their fathers, often grow distant and inconsistent after separation and overtime. Parents should realize that the victims of marital transition are the children. A source of chronic distress for children are anger and conflict before, during and after the divorce. Single or joint parenting can become unstable as one or both parents struggle with their own burdens such as the adverse economic consequences of divorce.

References

Garmezy, N. (1991). Resilience in children’s adaptation to negative life events and stressed environments.  Pediatric Annals, 20, 459–466.

Haggerty, R., Sherrod, L. & Garmezy, N. (1996). Parenting divorce and children’s wellbeing: A focus on resilience. Stress, Risks, and Resilience in Children and Adolescents:     Processes, Mechanisms, and Interventions. Cambridge, United Kingdom: Cambridge University Press.

Stanley, S., Markman, H, St. Peters, M & Leber, B. (1995). Strengthening Marriages and Preventing Divorce-New Directions in Prevention Research.  Family Relations, 44, 392-401.

McDermott, J. (1970). Divorce and its psychiatric sequelae in Children. Arch Gen Psychiatry, 23 (5), 421-427. : 10.1001/archpsyc.1970.01750050037006.

Community-based Participatory Research (CBPR) and Campaign on Early Prostate Cancer Screening

prostate health

Integral to a community organization and community building is community-based participatory research (CBPR) that gives researchers the opportunity to identify and address health policy questions at the local level. The theory which is relevant in my campaign for early screening of prostate cancer is ecological system perspective that will focus on the organization and technological forces that could help educate the target population on the management and development of the disease. Globally, cancer is the second leading cause of death, and it is essential for public health oncology to develop interventions to combat mortality and case burden successfully. In addition to the CBPR’s mechanism to increase the ability of health service researchers to impact health by motivating and supporting community partners to participate directly in the research process, and gives academic researchers access to local data. It also enhances interpretation of research findings through understanding of local context, and provides a natural infrastructure for affecting local policy through its community partners. Bridging partnership between academic researchers and community members will help identify the best approach to educate the target population on the potential benefits of early screening. Rimer, Briss, Zeller, Chan & Woolf (2004) stated that considering the complexity of issues regarding prostate cancer screening, experts recommend that men receive support in making informed decisions. This 2004 study of Rimer et al. further noted that competing clinical demands and the challenge of providing sufficient information to support decision making present important barriers to having this decision.

How far can we go to maximize the population’s uptake of screening? Woloshin, Schwartz, Black & Kramer, B. S. (2012) noted that one obvious approach was to use powerful tools of persuasion such as fear, guilt, and a sense of personal responsibility. Vulnerability can be induced by emphasizing the risk of the target population by framing statistics to provoke alarm, and then introduce hope by exaggerating the benefit of the intervention. These said, it is important for public health professionals to stay within the ethical boundary of the information campaign by increasing the awareness of screening’s benefits and risks so as to encourage informed personal decisions. Early prostate cancer screening with prostate-specific antigen (PSA) is controversial because it is not clear whether it reduces mortality and whether the potential benefits of screening and early detection outweigh the risks (Chan et al., 2003). The study added that a public health campaign could begin with a rationale for informed decision making by highlighting that regular prostate cancer screening with PSA may or will not reduce mortality. It is important to develop different strategies for different cultures and educational levels. Increased participation of patients may be required in informed decision making as technology improves in the detection of the disease at an earlier stage. This argument includes public health genomics, and the future of personalized prevention. Pashayan et al. (2013) stated that a risk-tailored screening program should first address the organizational and ethical, legal and social issues and commit to public engagement and education and to work with the health professionals delivering the program.

References

Braddock III, C. H., Edwards, K. A., Hasenberg, N. M., Laidley, T. L., & Levinson, W. (1999). Informed decision making in outpatient practice. JAMA: The Journal of the American Medical Association282(24), 2313-2320.

Chan, E. C., Vernon, S. W., O’Donnell, F. T., Ahn, C., Greisinger, A., & Aga, D. W. (2003). Informed consent for cancer screening with prostate-specific antigen: how well are men getting the message? American Journal of Public Health, 93(5), 779-785.

Glanz, K., Rimer, B., & Viswanath, K. (2008). Health Behavior and Health Education: Theory, Research, and Practice, 4th Edition, 4th Edition. Jossey-Bass, VitalBook.

Hoffman, R. M. (2011). Screening for prostate cancer. New England Journal of Medicine365(21), 2013-2019.

Love, R. R., Ginsburg, O. M., & Coleman, C. N. (2012). Public health oncology: a framework for progress in low-and middle-income countries. Annals of oncology, 23(12), 3040-3045.

O’Brien, M. J., & Whitaker, R. C. (2011). The role of community-based participatory research to inform local health policy: A case study. Journal of general internal medicine26(12), 1498-1501.

Pashayan, N., Hall, A., Chowdhury, S., Dent, T., Pharoah, P. D. P., & Burton, H. (2013). Public health genomics and personalized prevention: lessons from the COGS project. Journal of internal medicine274(5), 451-456.

Rimer, B. K., Briss, P. A., Zeller, P. K., Chan, E. C., & Woolf, S. H. (2004). Informed decision making: what is its role in cancer screening? Cancer, 101(S5), 1214-1228.

Woloshin, S., Schwartz, L. M., Black, W. C., & Kramer, B. S. (2012). Cancer screening campaigns—getting past uninformative persuasion. New England Journal of Medicine367(18), 1677-1679.

 

Preventive and Curative Health Care Services: Integrating Cultural Health Capital

Critical to improving the health of the US population is expanding the role of primary care in the prevention and treatment of childhood obesity. Providers can improve prevention and treatment through efforts in clinical and community setting, healthy lifestyle promotion, community health education, policy advocacy, weight status assessment and monitoring, clinic infrastructure development, and multi sector community initiatives. Coordinated and collective efforts in multiple sectors and settings are needed to address high prevalence of childhood obesity. There is a recognized need to expand the role of primary care to include advocacy in addition to traditional measurement of patients’ heights and weights to assess growth. It is important to identify successful models that integrate primary care, public health, and community-based efforts to accelerate progress in childhood obesity prevention. Vine, Hargreaves, Briefel & Orfield (2013) stated that based on 96 peer-reviewed articles published between 2005 to 2012, primary care providers (PCPs) are increasingly being included in childhood obesity interventions which is consistent with current recommendations from scientific and professional organizations. Being the critical stages of growth and healthy lifestyle development, prenatal and childhood periods need new strategies that encompass more than individual-level behavior change and post-assessment treatment. Well-child visits is the best timing to counsel parents about healthy lifestyle, mold healthy behaviors and refer families to community resources. It is necessary to stress the importance of PCPs to take on the role as educators, promoters of healthy lifestyle practices, and advocates in the broader community on treatment and intervention initiatives. Incorporating curative health services into broader population health is in essence within the scope of universal health coverage (UHC). Built on the 1978 Declaration of Alma Ata, Rodin (2013) stated that UHC movement reaffirmed that health is a human right and identified primary healthcare as the means for attaining “health for all” (p. 710). Transitioning towards UHC, it is necessary for government leaders and policy makers to take into consideration the unique health needs of women. It is important for policy makers to understand the biological and gender-based differences to successfully incorporate women’s needs into UHC schemes. The social protection schemes that cover women’s preventive services and curative services should seek to eliminate or at least reduce out-of-pocket spending on health and to remove the formidable financial barriers that prevent more women than men from accessing needed services (Rodin, 2013). The success or the efficient performance of UHC systems will be dependent upon the stakeholders’ focus on persistent differences between men and women’s health risks, health status, and access to service. Systematically including women’s health needs during the planning process of UHC will not only improve women’s empowerment, but also economic development.

Linguistic facility is a cultural health capital element that could be improved in order to understand, recognized and increase access to care for cultural and linguistic minorities utilizing ethnicity-specific subsystems of care. To create an organizational development model for ethnicity-specific health care organizations and infrastructures, it is useful to consider the historical experiences of the Chinese community in San Francisco. This model includes the development and recruitment of bicultural and bilingual healthcare workforce which will induce satisfying engagements between the target population and health professionals. The other stages in the development of this model are structuring health care resources for maximum accessibility, expanding health care organizations, and integrating ethnicity-specific health care resources into the mainstream health care system (Yang & Kagawa-Singer, 2007). This study further stated: “moving forward from the documentation of racial and ethnic disparities in health care toward long-term solutions that ameliorate disparities, ethnicity-specific health care organizations have untapped potential as a source for a strategy that addresses the structure of health systems that inhibit full access to quality health care for cultural and linguistic minorities” (p. 546). Ethnicity-specific health care systems can contribute to greater equity, comprehensive, and accessible quality care by greater expansion and integration of this health system into the mainstream. Delivering quality health care in culturally appropriate way, and opening the access which was impeded by cultural and linguistic characteristics could be efficiently implemented by matching of patients and providers. Integration of this system to the mainstream will need monitoring of discriminatory practices, and appropriate action to ensure fair competition among provider groups.

References

Baum, F. E., Legge, D. G., Freeman, T., Lawless, A., Labonté, R., & Jolley, G. M. (2013). The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints. BMC public health13(1), 460.

Rodin, J. (2013). Accelerating action towards universal health coverage by applying a gender lens. Bulletin of the World Health Organization91(9), 710-711.

Shim, J. K. (2010). Cultural Health Capital A Theoretical Approach to Understanding Health Care Interactions and the Dynamics of Unequal Treatment. Journal of Health and Social Behavior51(1), 1-15.

Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C. (2013). Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic-and Community-Based Recommendations and Interventions. Journal of obesity2013.

Yang, J. S., & Kagawa-Singer, M. (2007). Increasing access to care for cultural and linguistic minorities: ethnicity-specific health care organizations and infrastructure. Journal of Health Care for the Poor and Underserved18(3), 532-549.