Navigating New Norms of Involved Fatherhood: Employment, Gender Attitudes, and Father Involvement in American Families

In recent decades, gender roles have shifted toward greater overlap of men's and women's roles: women have entered the labor force in record numbers, while new norms of fatherhood emphasize men's involvement with their children in addition to their traditional role of financial provider. These "new fathers" are expected to be more equal partners in parenting, spending time nurturing children and performing both interactive and physical caregiving. However, men may face tension and conflict in attempting to fulfill their roles as both provider and involved father. The primary tension lies in the conflict of time and place: while the "new father" role requires spending time with children, the "provider" and "good worker" roles require a commitment to spending time on the job. How do men navigate these contradictory roles? To what extent does employment impact men's involvement with their children? Are men with more egalitarian attitudes trading off longer work hours for more time with their children? This dissertation examines these questions using two waves of the Child Development Supplement to the Panel Study of Income Dynamics (PSID-CDS), which offer rich measures of father involvement, employment, and gender attitudes. Specifically, it examines the relationship between employment and father involvement, and whether and how gender attitudes moderate that relationship. Statistical methods include cross-sectional and fixed effects OLS regressions. Results indicate that nontraditional attitudes toward the father's role, "new father" attitudes, are associated with both engagement with children and responsibility for their care, particularly engagement in physical care. Attitudes toward public and private roles of women, on the other hand, are not related to father involvement. Results further suggest that the "provider"/"good worker" role prevails for men, much the way the nurturer role tends to prevail for women. Despite inelastic work hours, however, there may in fact be a cohort of "new fathers" whose behavior matches their attitudes, in that they are 1) more involved with their children than more traditional fathers, and 2) they are able to preserve time with children, likely by cutting back on leisure time or incorporating their children into their leisure time

Adverse Childhood Experiences Screening Among Adults in an Inpatient Behavioral Health Unit

Adverse childhood experiences (ACEs) are common amongst people of all ages, races, and socio-economic statuses. The consequence of ACEs impact ones mental and physical health and life span. High ACE scores lead to increased risk of suicide, depression, anxiety, and substance abuse. The purpose of this project was to screen adults admitted to an inpatient psychiatric hospital for ACEs. This project sought to determine if there is a relationship between overall ACEs score and impact on health versus length of stay. Ultimately, the aim is to reduce negative health outcome for patients as measured by length of stay. The results indicated that overall ACEs score and the impact on health results did not impact length of stay. However, the results were significant in confirming that higher ACE scores are correlated with more significant impact on health

Sexual experience affects reproductive behavior and preoptic androgen receptors in male mice

Reproductive behavior in male rodents is made up of anticipatory and consummatory elements which are regulated in the brain by sensory systems, reward circuits and hormone signaling. Gonadal steroids play a key role in the regulation of male sexual behavior via steroid receptors in the hypothalamus and preoptic area. Typical patterns of male reproductive behavior have been characterized, however these are not fixed but are modulated by adult experience. We assessed the effects of repeated sexual experience on male reproductive behavior of C57BL/6 mice; including measures of olfactory investigation of females, mounting, intromission and ejaculation. The effects of sexual experience on the number of cells expressing either androgen receptor (AR) or estrogen receptor alpha (ERα) in the primary brain nuclei regulating male sexual behavior was also measured. Sexually experienced male mice engaged in less sniffing of females before initiating sexual behavior and exhibited shorter latencies to mount and intromit, increased frequency of intromission, and increased duration of intromission relative to mounting. No changes in numbers of ERα-positive cells were observed, however sexually experienced males had increased numbers of AR-positive cells in the medial preoptic area (MPOA); the primary regulatory nucleus for male sexual behavior. These results indicate that sexual experience results in a qualitative change in male reproductive behavior in mice that is associated with increased testosterone sensitivity in the MPOA and that this nucleus may play a key integrative role in mediating the effects of sexual experience on male behavior

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Genetics, genomics and precision medicine: Innovations in childhood cancer care through the eyes of families and oncology professionals

The successful implementation of precision medicine in childhood cancer care, including genomic testing for cancer predisposition syndromes, requires close examination of the experiences of key stakeholders. Taking a multi-perspective, mixed-methods approach, I conducted an in-depth investigation of the experiences of young patients, parents, and oncology professionals in the Australian healthcare context. After presenting a summary of the relevant literature in Chapter 1, I then conducted a systematic review (n=20 studies) of children and young adults’ understanding of, and attitudes towards, clinical genetic testing for hereditary diseases, and highlighted the unique information and support needs of young patients affected by/at risk of genetic conditions (Chapter 2). In Chapter 3, I examined families’ (n=26 parents, n=9 young adults) experiences of cancer-related genetic testing in childhood and identified their unique psychosocial challenges and information needs. In Chapter 4, I documented the challenges experienced by oncology professionals (n=39 clinicians, n=15 scientists) delivering precision medicine for poor prognosis childhood cancer. Finally, in Chapter 5, I examined parents’ (n=177) preferences, expectations and recall regarding clinically relevant germline findings in the context of a precision medicine trial for poor prognosis childhood cancer. The findings of this program of work affirm the need for specialised paediatric precision medicine informational resources and supportive practices, to educate and empower families, including young patients, so that they can experience the benefits of advancing technologies without risk of deleterious psychosocial consequences. The thesis also addresses the potential for the development and evaluation of professional development initiatives to support paediatric oncology professionals in navigating the unique challenges of genomic precision medicine

Implementation of the Brøset Violence Checklist for Adult Psychiatric Patients

Violence has become an increasing issue in healthcare systems worldwide, especially in inpatient psychiatric units. Violence can lead to harmful effects for patients and staff members and has been shown to increase the risk of depression, anxiety, and suicide. Additionally, violence has been shown to lead to staff burnout, which in turn leads to poorer patient outcomes. This project aimed to decrease rates of violence by implementing the Brøset Violence Checklist (BVC), a screening tool that predicts imminent violence. The BVC is a six-item checklist that allows patients to be scored based on behaviors. Then, a sum score is produced, and recommended interventions are available. The BVC was used to score patients once each shift and on admission at two psychiatric facilities in the southern United States. Baseline data was collected for the two months prior to the implementation period and compared to data from the implementation period, which lasted two months. Data variables collected included demographics, admission diagnosis, number of violent incidents per patient, the shift that the BVC was completed on, the sum of the BVC score, and interventions that occurred. Ultimately, there was no statistically significant difference in the rate of violent incidents in the pre-implementation period versus the implementation period. However, the BVC still showed some promise. Of the individuals who had at least one violent incident, at facility one, there was a statistically significant decrease in the number of violent incidents per patient from the pre-implementation period to the implementation period. Additionally, at facility two, there was a practically significant decrease in the use of restraints and seclusion. The use of a structured risk assessment tool, such as the BVC, has shown potential for reducing violence much more effectively than chance alone

"This is the first time I've talked about this": considerations when conducting qualitative research interviews with adolescents and young adults with cancer

ualitative research is a useful and important way to describe and analyze the experiences of adolescents and young adults (AYAs) with cancer. However, undertaking qualitative research with AYAs living with, or beyond, a cancer diagnosis requires careful planning and a well-informed approach for participants with a high level of vulnerability and who are at a crucial stage developmentally. This article reflects on the challenges of including AYAs with cancer between the ages of 16 and 25 years in qualitative research. By drawing on each author's own experiences of engaging in qualitative research interviews with AYAs with cancer, the article provides suggestions regarding how best to manage challenges and yield valuable data describing their experiences. Insights that are shared between qualitative researchers in this field may assist in preparing for the challenges posed by conducting qualitative research with this group and may help researchers to manage this activity successfully

Decision-making in childhood cancer parents’ and adolescents’ views and perceptions

Purpose Few studies have addressed the way in which families of children with cancer make treatment decisions, and how we can meet parents’ and young peoples’ decisional involvement needs. We aimed to explore parents’ and adolescents’ views and perceptions of making medical decisions in pediatric oncology. Methods We conducted semi-structured interviews with 25 parents of children diagnosed with cancer in the past 12-months, and 5 adolescents diagnosed in the past 12-months. Our interview schedule was underpinned by Elwyn and Miron-Shatz’s decision-making model. The model acknowledges the deliberation (process of coming to a decision) and determination (making a choice) phases of decision-making. We conducted a thematic analysis. ResultsOur findings indicate that information provision is not enough to facilitate parents’ decision-making involvement. Many parents sought additional information to meet their individual needs and preferences. While many parents and young people desired decisional involvement, they trusted the doctors to make treatment decisions. Feelings of distress, inadequacy and lack of choice impacted decision-making participation. Regardless, many parents in our study were satisfied with treatment decisions, but this was largely dependent on positive treatment outcomes. ConclusionOur study contributes to understanding how families of a child with cancer make treatment decisions. Families tend to rely on doctors to make treatment decisions, but often seek additional information to help them feel involved in the decision process. Findings highlight that decision-making in pediatric oncology should focus on involving families in the deliberation phase, rather than just determination of choice.<br/

Cancer-Related Genetic Testing and Personalized Medicine for Adolescents: A narrative review of impact and understanding

Genetic testing is becoming increasingly available for adolescents who are undergoing cancer treatment or at risk of cancer predisposition syndromes. With this narrative review, we aimed to synthesize the evidence on psychosocial outcomes and adolescents' understanding of genetic testing-thus far, an underresearched topic. Both psychological benefits and harms of predictive testing were reported in adolescents from high-risk families. Harms were mainly related to cancer-specific distress and increased worries. Findings on genetic understanding were sparse. Future studies should focus on psychosocial outcomes and adolescents' understanding undergoing genetic testing and enabling access to genetic counseling pre-testing and post-testing