Lack Of Social Integration Research Articles

EXPLORING REASONS THAT U.S. MD-PHD STUDENTS ENTER AND LEAVE THEIR DUAL-DEGREE PROGRAMS.

Aim/PurposeIn response to widespread efforts to increase the size and diversity of the biomedical-research workforce in the U.S., a large-scale qualitative study was conducted to examine current and former students’ training experiences in MD (Doctor of Medicine), PhD (Doctor of Philosophy), and MD-PhD dual-degree programs. In this paper, we aimed to describe the experiences of a subset of study participants who had dropped out their MD-PhD dual-degree training program, the reasons they entered the MD-PhD program, as well as their reasons for discontinuing their training for the MD-PhD.BackgroundThe U.S. has the longest history of MD-PhD dual-degree training programs and produces the largest number of MD-PhD graduates in the world. In the U.S., dual-degree MD-PhD programs are offered at many medical schools and historically have included three phases—preclinical, PhD-research, and clinical training, all during medical-school training. On average, it takes eight years of training to complete requirements for the MD-PhD dual-degree. MD-PhD students have unique training experiences, different from MD-only or PhD-only students. Not all MD-PhD students complete their training, at a cost to funding agencies, schools, and students themselves.MethodologyWe purposefully sampled from 97 U.S. schools with doctoral programs, posting advertisements for recruitment of participants who were engaged in or had completed PhD, MD, and MD-PhD training. Between 2011-2013, semi-structured, one-on-one phone interviews were conducted with 217 participants. Using a phenomenological approach and inductive, thematic analysis, we examined students’ reasons for entering the MD-PhD dual-degree program, when they decided to leave, and their reasons for leaving MD-PhD training.ContributionStudy findings offer new insights into MD-PhD students’ reasons for leaving the program, beyond what is known about program attrition based on retrospective analysis of existing national data, as little is known about students’ actual reasons for attrition. By more deeply exploring students’ reasons for attrition, programs can find ways to improve MD-PhD students’ training experiences and boost their retention in these dual-degree programs to completion, which will, in turn, foster expansion of the biomedical-research-workforce capacity.FindingsSeven participants in the larger study reported during their interview that they left their MD-PhD programs before finishing, and these were the only participants who reported leaving their doctoral training. At the time of interview, two participants had completed the MD and were academic-medicine faculty, four were completing medical school, and one dropped out of medicine to complete a PhD in Education. Participants reported enrolling in MD-PhD programs to work in both clinical practice and research. Very positive college research experiences, mentorship, and personal reasons also played important roles in participants’ decisions to pursue the dual MD-PhD degree. However, once in the program, positive mentorship and other opportunities that they experienced during or after college, which initially drew candidates to the program was found lacking. Four themes emerged as reasons for leaving the MD-PhD program: 1) declining interest in research, 2) isolation and lack of social integration during the different training phases, 3) suboptimal PhD-advising experiences, and 4) unforeseen obstacles to completing PhD research requirements, such as loss of funding.Recommendations for PractitionersThough limited by a small sample size, findings highlight the need for better integrated institutional and programmatic supports for MD-PhD students, especially during PhD training.Recommendations for ResearchersResearchers should continue to explore if other programmatic aspects of MD-PhD training (other than challenges experienced during PhD training, as discussed in this paper) are particularly problematic and pose challenges to the successful completion of the program.Impact on SocietyThe MD-PhD workforce comprises a small, but highly -trained cadre of physician-scientists with the expertise to conduct clinical and/or basic science research aimed at improving patient care and developing new diagnostic tools and therapies. Although MD-PhD graduates comprise a small proportion of all MD graduates in the U.S. and globally, about half of all MD-trained physician-scientists in the U.S. federally funded biomedical-research workforce are MD-PhD-trained physicians. Training is extensive and rigorous. Improving experiences during the PhD-training phase could help reduce MD-PhD program attrition, as attrition results in substantial financial cost to federal and private funding agencies and to medical schools that fund MD-PhD programs in the U.S. and other countries.Future ResearchFuture research could examine, in greater depth, how communications among students, faculty and administrators in various settings, such as classrooms, research labs, and clinics, might help MD-PhD students become more fully integrated into each new program phase and continue in the program to completion. Future research could also examine experiences of MD-PhD students from groups underrepresented in medicine and the biomedical-research workforce (e.g., first-generation college graduates, women, and racial/ethnic minorities), which might serve to inform interventions to increase the numbers of applicants to MD-PhD programs and help reverse the steady decline in the physician-scientist workforce over the past several decades.

Las razones del miedo: deserción temprana de Beca 18

This article explores the reasons why low-income students, who are supported by a public scholarship program called “Beca 18”, reject this support or leave their studies during the first year of studies. Results are based on two methods: a quantitative model that compares personal and family characteristics among deserters and non-deserters, and a qualitative approach based on in-depth interviews with deserters in order to inquire about the reasons for not accepting the scholarship or early withdrawal. This article prioritizes the qualitative approach because the quantitative does not show significant differences between the two groups. The evidence indicates that the main reasons that explain the early drop-out or non-acceptance of Beca 18 are the affective factors and the lack of social integration into the new environment.

Australian homeless persons' experiences of social connectedness, isolation and loneliness.

Both loneliness and a lack of social integration are associated with serious physical and psychological health issues. One population highly susceptible to social isolation and loneliness are individuals who are homeless, who also experience high rates of mental disorder and relationship breakdown. Despite this, little research has explored how social networks, isolation and loneliness are experienced for those with a history of homelessness. In-depth, semi-structured interviews were used to get a nuanced understanding of how social networks and isolation are experienced and understood by individuals experiencing homelessness. Sixteen participants who were either homeless (n=11) or previously homeless (n=5) in Sydney, Australia, completed one-off interviews that were audio-recorded and transcribed. Data were analysed using thematic analysis. Participants constructed their social networks as being both constrained and enabled by marginalisation. They experienced rejection from the non-homeless: the loss of critical network members, including rejection from family and a lack of companionship, and low quality and precarious relationships within the homeless community. These accounts were best conceptualised through loneliness theory. Participant's accounts signal that the homeless will likely continue feeling isolated if mainstream attitudes towards homelessness remain stigmatising and discriminatory.

‘Ménages irréguliers’: interracial liaisons in colonial Indochina, 1905–1938

This article explores the history of relationships between Vietnamese women and French men in colonial Indochina as well as the multiplicity of perspectives on these unions. Relationships between Vietnamese women and French men were shaped by a lack of social integration and the skewed sex ratio among the French populations in the region. For French colonizers, these unions complicated the legal and social criteria for ‘being French’ in the colony and were perceived as both a practical necessity and a political threat. Vietnamese discourse on interracial unions demonstrated a preoccupation with changing sexual norms as well as preservation of cultural traditions. By engaging with both Vietnamese and French sources, the article moves away from mainstream colonial Eurocentric parlance that typically cast Vietnamese women as dominated and powerless, and instead highlights the women’s various degrees of agency as well as different motivations and practices in interracial unions.

Testing the Interpersonal Theory of Suicide in Chronic Pain.

The interpersonal theory of suicide offers a conceptual framework for understanding suicidal ideation (SI) that may be applicable to individuals with chronic pain. The theory emphasizes the importance of 2 interpersonal constructs as precursors to SI: perceived burdensomeness (the belief that one has become a burden to others) and thwarted belongingness (a lack of social integration or connection). Our objective was to test the interpersonal theory of suicide in people with chronic pain. Hierarchical regression analysis was used in a cross-sectional study of 282 patients of an interdisciplinary pain clinic. The Beck Scale for Suicide Ideation was the criterion measure of SI, and independent variables included both general and pain-specific predictors. After adjusting for other known or putative risk factors related to pain and mental health, perceived burdensomeness significantly predicted SI, whereas thwarted belongingness did not. As expected according to theory, the interaction between perceived burdensomeness and thwarted belongingness was also significant; perceived burdensomeness was a strong predictor of SI at high levels of thwarted belongingness, but only marginally at low levels. Other independent predictors were male sex, number of prior suicide attempts, and hopelessness. These findings are in line with some, but not all, of the major predictions of the interpersonal theory of suicide. In general, however, they support the relevance of the theory for individuals with chronic pain.

Conflict and insecurity: A sociological perspective on perceptions of insecurity in conflict-affected Democratic Republic of Congo

This article focuses on insecurity perceptions in conflict-affected areas. The authors apply sociological theories on the determinants of perceived security risks and test hypotheses concerning theories on social and physical vulnerability, social disorder and social integration in the area where the Lord’s Resistance Army (LRA) has operated. The study uses data from a survey conducted in 2013 in the territory of Faradje (Haut-Uele) and applies multilevel models to 443 individuals living within 21 different villages and internally displaced persons (IDP) camps. The results indicate that insecurity perceptions and fear of attacks are still widespread, causing individuals to adapt their behaviour and IDPs to refrain from returning home. These concerns are unaffected by social and physical vulnerabilities. The study finds a positive significant effect of the presence of IDPs in the villages and IDP camps on insecurity perceptions. This suggests possible effects of social disorder and a lack of social integration due to the arrival of IDPs in the area. Although improving the security situation itself is an important factor, this article shows that addressing insecurity perceptions might be an important factor as well.

Locating and applying sociological theories of risk-taking to develop public health interventions for adolescents

Sociological theories seldom inform public health interventions at the community level. The reasons for this are unclear but may include difficulties in finding, understanding or operationalising theories. We conducted a study to explore the feasibility of locating sociological theories within a specific field of public health, adolescent risk-taking, and to consider their potential for practical application. We identified a range of sociological theories. These explained risk-taking: (i) as being due to lack of social integration; (ii) as a consequence of isolation from mainstream society; (iii) as a rite of passage; (iv) as a response to social constraints; (v) as resistance; (vi) as an aspect of adolescent development; (vii) by the theory of the ‘habitus’; (viii) by situated rationality and social action theories; and (ix) as social practice. We consider these theories in terms of their potential to inform public health interventions for young people.

Investigation of the marked and long-standing spatial inhomogeneity of the Hungarian suicide rate: A spatial regression approach

BackgroundIn the last century Hungary had astonishingly high suicide rates characterized by marked regional within-country inequalities, a spatial pattern which has been quite stable over time. AimsTo explain the above phenomenon at the level of micro-regions (n=175) in the period between 2005 and 2011. MethodsOur dependent variable was the age and gender standardized mortality ratio (SMR) for suicide while explanatory variables were factors which are supposed to influence suicide risk, such as measures of religious and political integration, travel time accessibility of psychiatric services, alcohol consumption, unemployment and disability pensionery. When applying the ordinary least squared regression model, the residuals were found to be spatially autocorrelated, which indicates the violation of the assumption on the independence of error terms and – accordingly – the necessity of application of a spatial autoregressive (SAR) model to handle this problem. According to our calculations the SARlag model was a better way (versus the SARerr model) of addressing the problem of spatial autocorrelation, furthermore its substantive meaning is more convenient. ResultsSMR was significantly associated with the “political integration” variable in a negative and with “lack of religious integration” and “disability pensionery” variables in a positive manner. Associations were not significant for the remaining explanatory variables. LimitationsSeveral important psychiatric variables were not available at the level of micro-regions. We conducted our analysis on aggregate data. ConclusionOur results may draw attention to the relevance and abiding validity of the classic Durkheimian suicide risk factors – such as lack of social integration – apropos of the spatial pattern of Hungarian suicides.

Parent-child value similarity and subjective well-being in the context of migration: An exploration

Intergenerational value similarity has a different meaning for migrants and minorities compared to the majority society. Whereas high parent-child value similarity among majority families more likely indicates successful internalization of societal values, high intergenerational similarity among migrants may indicate a lack of social integration into the host society. The present paper links parent-adolescent value similarity among migrant/minority and majority families to subjective well-being in two societies, Germany and Israel (Total N = 977 families). Analyses assess intergenerational similarity on all values from the Schwartz value circumplex. Among majority groups intergenerational value similarity is a predictor of life satisfaction. In minority groups it is more so a low distance of a family's value preferences to the modal values of the majority group that predicts life satisfaction – but only in Israel.

L'état de santé des migrants de première et de seconde génération en France

Résumé À partir de l’enquête française Santé Protection Sociale menée en 2006, cette étude analyse les inégalités de santé liées à la migration. Les résultats suggèrent des disparités d’état de santé entre la population immigrée et la population française particulièrement marquées chez les émigrés d’Afrique du Nord. L’ampleur de ces inégalités est plus élevée chez les immigrés de première génération que chez les immigrés de seconde génération. Elles sont également plus notables chez les femmes que les hommes. Le mauvais état de santé des hommes immigrés est principalement expliqué par leur situation économique et sociale, leur intégration sociale et par leur hygiène de vie, alors que chez les femmes la migration constitue un risque spécifique.

The ethical imperative to scale up health care services for people with severe mental disorders in low and middle income countries

Most mentally ill people in low and middle income countries, where clinical services are typically scarce and mental health legal provisions often inadequate, do not receive requisite evidence based treatment....

Health Status in Immigrants and Native Early Adolescents in Italy

The aim of the study was to compare health status between native and immigrant early adolescents in Italy and to analyze related psychosocial factors. Data were taken from "Health Behavior in School Aged Children", a cross-sectional survey investigating health behaviors among early adolescents in selected European countries. A representative sample of 6,744 (50.4% males) Italian students (11, 13 and 15-years-old) completed a questionnaire. Students were assessed for demographics characteristics, socio-economic conditions, social support and bullying victimization, and, as dependent variables, for health complaints, self-reported health, life satisfaction and happiness. It turned out that immigrant adolescents, as compared to natives, are more often affected by psychosomatic symptoms, less satisfied about their health and about life, and less happy. A multiple regression model showed that migration itself is related to life satisfaction and happiness. Socio-economic inequalities, lack of social integration and victimization determine the differences between immigrants and natives in terms of health symptoms and self-reported health. Immigrant adolescents demonstrated worse health status then their native classmates. However, the differences in terms of subjective well-being are not explained by socio-economic differences, lack of social integration and discrimination.

Adolescent Same-Sex Attraction and Academic Outcomes: The Role of School Attachment and Engagement

Schools create environments in which some sexual feelings, behaviors, and relationships are stigmatized, and this may have negative consequences for adolescents with nonheterosexual romantic attractions. This stigma can lead them to withdraw and disengage from school at a critical time of preparation for adulthood, which can compromise opportunities for future success. Previous research has demonstrated that sexual minority youth report greater levels of school-related problems, including a weaker sense of attachment to school and more trouble with teachers and peers. This lack of social integration is likely to affect their educational success. Data from the National Longitudinal Study of Adolescent Health and the newly collected Adolescent Health and Academic Achievement study provide the first opportunity to fully explore whether and to what extent same-sex attracted youth enter adulthood with an educational disadvantage. In this study, we examine (1) whether same-sex attracted adolescents have lower levels of academic success, (2) if their lower academic success is explained by a lack of social integration at school, and (3) whether these relationships differ for boys and girls. Results suggest that same-sex attracted students, particularly boys, do suffer academically, and that this is in part a result of school-related problems and risk factors such as emotional distress and substance use; however, a great deal of the disadvantage fails to be explained by these factors. Additionally, while same-sex attracted boys show poorer academic performance, same-sex attracted girls do not, suggesting that gender may shape how sexual minority youth experience and respond to marginalizing school environments.

Relation of Social Integration to Inflammatory Marker Concentrations in Men and Women 70 to 79 Years

The lack of social integration has predicted coronary heart disease morbidity and mortality in prospective observational studies; however, the biologic mechanisms by which this may occur are not well understood. The objective of this study was to determine whether social integration is associated with inflammatory risk factors for coronary heart disease, specifically C-reactive protein (CRP) and interleukin-6. The study participants (aged 70 to 79 years; 380 men and 425 women) were from the MacArthur Successful Aging Study, a longitudinal study of 3 community-based cohorts in the United States of older adults with relatively high physical and cognitive functioning at baseline (1988 to 1989). The plasma concentrations of interleukin-6 and CRP were assessed using a high-sensitivity enzyme-linked immunosorbent assay. Cross-sectional logistic regression analyses were performed. Multivariate adjusted analyses indicated that social integration was significantly inversely associated with CRP concentration in men after adjusting for age, race/ethnicity, smoking, alcohol consumption, physical activity, body mass index, cardiovascular disease, other major or chronic conditions, physical functioning, socioeconomic status, and depression (odds ratio 2.23, 95% confidence interval 1.05 to 4.76, for elevated CRP [>3.19 mg/L] in the least socially integrated quartile vs the most socially integrated quartile). No significant associations were found between social integration and interleukin-6 in men or either inflammatory marker in women. In conclusion, social integration was negatively associated with the plasma CRP concentration in men. These findings suggest a potential biologic mechanism for the observed associations between social integration and coronary heart disease in prospective studies. Differences may exist between women and men in the biologic pathways associated with social integration.

Community-based household waste management: Lessons learnt from EXNORA's ‘zero waste management’ scheme in two South Indian cities

This paper presents two case studies on the efforts by a community-based organisation to promote a sustainable integrated waste management system in Indian mega cities. This effort was initiated in 1989 by a local non-governmental organisation (NGO) called EXNORA and is based on a ‘zero waste management scheme’ set up, run and financed by the residents themselves. As this model has been widely quoted as successful, the study aims at learning from two communities implementing this model. Results are reported from a survey of the two schemes that used various tools to assess both their performance and sustainability in selected residential areas of two Indian cities, Chennai and Hyderabad. The results indicate limited success of the schemes both in saving a significant fraction of the generated waste from dumping, and in rehabilitating the local poor. However, they show that motivated individuals can successfully set up and manage waste collection systems that lead to overall environmental improvements. The differences in the two schemes reflect how the local assets and contexts impact on the success of the scheme. The scheme in a rich neighbourhood of Hyderabad was less ambitious in its overall objectives and focussed on the provision of a waste management service, using the opportunity to provide local employment to a socially deprived fraction of the population. The scheme in a middle-class area of Chennai, although pioneering in its approach, suffered from diseconomies of scale and lack of social integration, making it less viable in the medium to long term. Both schemes suffered from a lack of community involvement, motivation and political support, which threatens the long-term sustainability of the enterprise. The research concludes that the role that communities can realistically play in management of their own waste depends on the local context. The system advocated by EXNORA seems to require significant local resources, and political and technical support which are hard to find and sustain without strong local leaders. Another model set up in the city of Visakhapatnam is finally introduced as an alternative. This is based on triangular contracts between the municipality, the residents and micro-enterprises and may provide a good solution in dealing with the technical and commercial aspects which communities find difficult.

Gender Differences in the Link Between Depression and Cardiovascular Disease

Cardiovascular disease is the leading cause of mortality in women costing more than 500,000 lives each year in the United States alone. Major depression in healthy subjects increases cardiovascular mortality in both men and women. The presence of major depression in patients with recent acute myocardial infarction (AMI) or unstable angina more than doubles the risk of cardiac death in both men and women. In the presence of depression, lack of social integration has an additive effect on cardiac events. Depression is more prevalent in women with coronary heart disease (CHD) than in men. Psychologic counseling as well as cognitive behavioral treatment in women post-AMI seems to adversely affect prognosis, whereas it has neutral effects in men. Pharmacologic treatment of depression with serotonin reuptake inhibitors is safe in men and women post-AMI and is particularly effective in patients with recurrent depression. Whether effective treatment of depression lowers cardiac mortality remains to be proven.

Stress, burnout and health in the clinical period of dental education

The study examined the extent of stress, burnout and health problems experienced by fourth and fifth year dental students from the three universities of Dresden, Freiburg and Bern. The objectives of the study were to: (i) identify frequent sources of stress and to report the prevalence rates of burnout and health problems in dental students, (ii) determine the rate of students suffering from severe burnout symptoms and (iii) identify stress factors related to the burnout symptoms of emotional exhaustion and depersonalization. A total of 161 dental students from Dresden, Freiburg and Bern participated in the study. They completed the Psychosocial Stress Inventory, the Maslach Burnout Inventory and the Health Survey Questionnaire. Frequent sources of stress were limitation of leisure time, examination anxiety and the transition stress that was related to the adaptation to the demands of the clinical phase of dental education. Few differences existed between the students of the fourth and the fifth study year. Study-related stress was lowest in Bern and considerably higher in Dresden. Differences of mean levels of burnout symptoms were found only for the burnout dimension of emotional exhaustion. Students from Dresden and Freiburg were more emotionally exhausted than students from Bern, students from Dresden also reported more health problems than students from Bern or Freiburg. Ten per cent of the dental students suffered from severe emotional exhaustion, 17% complained about a severe lack of accomplishment and 28% reported severe depersonalization symptoms. Forty-four per cent of the variance of emotional exhaustion was explained by study-related factors such as lack of leisure time, examination anxiety and transition stress. The only predictor of depersonalization was a lack of social integration, accounting for 3% of the variance. A lack of social integration may be an indicator of low social competence which may cause difficulties in dealing with patients adequately and therefore result in depersonalization. The results indicate a need to identify the group of students who may have insufficient social skills for dealing adequately with the patients, and to train them accordingly.

Suicide Prevention in Older Adults.

Older adults have high rates of suicide in the United States and worldwide; rates vary markedly by gender, race, and ethnicity. Ceropsychology practice guidelines (e.g., American Psychological Association [APA], 2004) indicate the need for assessment and treatment practices specific to older adults, as the phenomenology of mental disorders and psychotherapeutic change processes may shift across the lifespan. Inadequacies in the available knowledge base and in the education and training of clinicians have slowed progress in suicide research and hindered the development of a healthcare workforce that is deeply dedicated to suicide prevention. Inadequate knowledge stems from inattention to demographic differences, definitional imprecision and conceptual conflation, lack of research focus on older adults, and the exclusion of at-risk patients from clinical trials. The near absence of rigorous training and education in suicidology among clinical psychologists amplifies these problems. This article also reviews the empirical literature on suicide risk, noting in particular the roles of mood disorders, suicidal ideation and behavior, adjustment to life events, lack of social integration, personality traits, and access to lethal means. Suggestions are offered for improving risk assessment, the treatment of at-risk patients, and the development of prevention programs. Implications for training and education in clinical psychology are briefly discussed, and directions for future research are offered.

Stopping Out and Persisting: Experiences of Latino Undergraduates

This study examines the experiences that 10 Latino recent undergraduate students reported having at a large midwestern university. Five persisted through graduation, and five stopped out. Both groups described similar home environments, a lack of social integration, and feelings of academic unpreparedness. Differences among groups were academic difficulties, home-to-school transition, high school segregation, anticipatory socialization, first contact with the university, and education and career goals. The study's implications suggest several approaches to increasing Latino persistence.

Migration of Ethnic Greeks from the Former Soviet Union to Greece, 1990-2000: Policy Decisions and Implications

In the 1990s a flow of ethnic Greek immigrants from the former Soviet Union to Greece created several challenges for the Greek state, which attempted to assist in their settlement and social integration, and for the immigrants themselves, since their problems were increased upon their arrival. Language barriers, unemployment, lack of quality housing options and the overall lack of social integration continue to plague them as they lose faith in Greece and in themselves. The Greek state has introduced relevant policies but the lack of implementation of laws and projects has rendered the whole attempt ineffective. However, new policies could give these people hope for a prosperous future.