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By U. Hassan. Armstrong Atlantic State University.

Overall buy proscar 5 mg low price, forensic dentistry includes multiple areas of scientifc study generic proscar 5mg free shipping, where the legal system and dentistry coincide 5mg proscar free shipping. Tis specialized area of dentistry includes the gathering and interpretation of dental and related evidence within the overall feld of criminalistics discount proscar 5 mg fast delivery. Forensic dental evidence ranges from the identifcation of persons using dental records (Chapter 9) to the identifcation and analysis of bitemarks on an object such as a food item, or a bitemark on a victim compared to a suspect, or on a suspect compared to a victim (Chapter 14), to the estimation of a person’s age based upon dental development or other characteristics (Chapter 13). Te forensic dentist is ofen an expert witness in civil disputes where dental injuries are at issue or there is a question of dental malpractice. Legal science, the law, and Forensic identifcation liability cases relating to injuries to the teeth, mouth, or jaw may involve the expertise of a forensic dentist (odontologist). A qualifed dental expert can provide opinion testimony on issues relating to the loss or damage to teeth and the efect of the loss or damage to an injured individual. For example, if a person was involved in an automobile accident or an altercation where legal liability is in question, the forensic dentist may explain to the jury how the accident or assault caused the dental injury to occur. In criminal cases, the forensic dentist will assist the judge or jury by relating expert testimony concerning a dental identifcation examination or by identifying bitemarks and giving an opinion as to who may have made the bitemark (Chapter 16). Dental identifcation of a person from dental records by a qualifed forensic dentist has long been established and accepted by courts as a means to prove the identity of an individual (Chapter 9). A question as to the identi- fcation of a person may arise from a mass disaster, such as an airplane crash, natural disaster, or a situation where multiple people died in a fre and the bodies are not otherwise recognizable (Chapter 12). Dental identifcations relying on x-rays and dental records universally have been considered to be a reliable identifcation method and rarely has a legal challenge been raised in court. Age estimation using dental evidence is necessary when a question arises as to a person’s correct age as it relates to court proceedings. Typically, if a person is accused of a crime, it may be signifcant to determine if the individual is a minor and therefore subject to the juvenile court jurisdic- tion or whether the person has reached adulthood, where he or she would be prosecuted as an adult (Chapter 13). Each of these subdisciplines of forensic dentistry is discussed in one or more of the chapters of this book. Forensic bitemark evidence to determine identity has become controversial over the last decade and has undergone a fundamental challenge by the greater sci- entifc community. Highly variable loci are called polymorphic and are useful to identify biological material as unique (discussed further in Chapter 7). Tis maternal inheritance pattern has two important implications in forensic testing. In order to understand the present status of forensic dentistry as a foren- sic identifcation science within the overall forensic science community, it is helpful to understand and trace the history of the development of forensic dentistry. As with many changes in our American society, forensic dentistry emerged as the result of landmark events (cases) that established and shaped forensic dentistry as a useful scientifc tool within the greater forensic science legal community. Te issue of the scientifc admissibility of bitemark evidence was established in 1976 in a landmark case in California. Te use of bitemark evidence afer that case grew dramatically and bitemark evidence became a sought-afer identifcation technique by law enforcement and prosecutorial agencies. Additional new bitemark identifcation methods were developed and used in thousands of cases throughout the United States and around the world (see Marx in Chapter 14). In a noteworthy case from the state of Florida, a clean-cut serial killer, originally from Washington state, was convicted and eventually sentenced to death based upon bitemark evidence. Te signifcance of this case sent a clear message to law enforcement in the United States and elsewhere that bitemark evidence could be a critical link in establishing proof of identity and obtaining a conviction. Te case received widespread media attention, which resulted in public acknowledgment and acceptance of bite- mark evidence (see Bundy in Chapter 14). Beginning in the later half of the 1990s, the forensic science community was shaken by numerous instances where errors occurred in cases and indi- viduals were exonerated afer a determination was made that they were wrong- fully convicted. In the discipline of forensic dentistry, a milestone case of a wrongful con- viction was the case of Ray Krone, convicted and sentenced to death for a capital murder. He was the hundredth person in the United States who had been sentenced to death to walk free from prison since the reinstatement of the death penalty in the United States in 1977. Without them, there likely would have been no Jury submissable case against Krone. Te suspect was sentenced to death for the murder of his girl- friend’s three-year-old daughter. Even though other forensic dentists con- cluded that the marks were not even bitemarks, the jury found him guilty. Improved technology and an increasing awareness of previously untested assumptions by forensic dentists have developed. Tis is the result of a concerted efort by some forensic dentists to build a solid scientifc foundation and reliable protocols for bitemark comparisons. As a direct result of past mistakes there is now a better understanding by forensic dentists of the inherent variability and resulting distortion of marks lef by human teeth in human skin. Tere is an increasing acceptance by forensic dentists that there is rarely, if ever, a scientifc basis to justify an opinion that a specifc person in an open population made a bitemark on human skin with scientifc certainty, be it total or reasonable, science, the law, and Forensic identifcation based solely on the analysis of the pattern information. Scientifc studies being performed by forensic dentists are expected to demonstrate that there are reliable methods and approaches to comparing bitemark evidence that minimize the potential for subjective bias and other factors that have, in the past, led to errors. As these studies are examined and other studies are undertaken by the forensic dental community they are expected to improve this troubled area of forensic science. However, forensic odontologists and court reporters were very rare at that time; there is no dependable record of the event, analysis, comparisons, or testimony. Moreover, there were a limited number of suspects in this closed-population case and the suspects reportedly confessed. Agrippina the Younger, fourth wife of Emperor Claudius I and the ambitious mother by a previous marriage of Nero, contracted for the death of Lollia Paulina. To ensure that the contract was accurately concluded, Agrippina had Paulina’s head brought to her. Te confrmation of identifcation was made based on dental mis- alignments and other peculiarities. A signifcant battle during the invasion of the sacred city of Kanauji involved the sacking of the holy shrines of Muttra, the birthplace of Krishna, an important site in the Hindu religion. During the siege, Jai Chand, the Raja of Kanauji, was murdered afer being taken prisoner and was identifed by his false teeth when he was found among those slain. Te duke’s page was able to identify him according to his dentition, as he had lost some teeth in a fall years previously. Te fort was later captured by British General Forbes, who arranged to have the dead buried prior to leaving for Philadelphia. Tree years later, a Native American who had fought in the battle remembered Ofcer Halket and was able to lead Halket’s son to the area where he was killed during the battle. Joseph Warren—Paul Revere In Boston in 1776, at the battle for Breed’s Hill (often misidentified as Bunker Hill), Dr. His face was unrecogniz- able as he suffered a fatal head wound, a rifle ball to the left side of his face.

The practice of reusing disposable catheters for more than one pass seems to be based on anecdotal evidence that infection risks are not increased buy generic proscar 5mg line. Without substantive evidence buy 5 mg proscar fast delivery, nurses reusing catheters should consider their professional accountability order proscar 5 mg free shipping, and the legal liabilities of reusing equipment labelled by manufacturers as single-use (de Jong 1996) buy proscar 5 mg free shipping. Using clean (rather than sterile) gloves for suction similarly appears based on anecdotal claims that infection rates are not significantly increased. Gloves of any sort protect (universal precautions) nurses, and clean gloves are both quicker to put on and cheaper; with gloved hands not touching catheter tips, infection risks appear small, but any substantive evidence to support this is lacking (Odell et al. Ventilation continues during catheter insertion and so catheters should be advanced more carefully to reduce trauma (passes should not be slowed so much that patient discomfort is increased). Concerns that they create reservoirs for microbial colonisation appear to be unfounded (Adams et al. Nurses’ concerns that closed circuit catheters may be more difficult to manipulate (Graziano et al. Closed circuit systems can be cost effective if they replace sufficient numbers of disposable items. Most manufacturers recommend replacement after 24 hours; Quirke (1998) found 48-hour changes safe and suggests that further research may support weekly changes; however, staff should remember their legal liability if flouting manufacturer’s recommendations. Widespread practice of saline instillation to loosen secretions has little support beyond anecdotal literature. Mucus is not water soluble and so will not easily mix with saline; encrustations on dentures can be difficult to remove after soaking overnight, and a few seconds contact with saline seems unlikely to significantly loosen airway encrustations. Ackerman (1993) found saline instillation reduced PaO2, possibly from bronchospasm or creating a fluid barrier to gas perfusion. However Ackerman’s methodology alternated use and non-use of saline in the same patients, ignoring possible late complications of consolidation through inadequate removal of mucus. Temperature differentials between cold fluids and airways may trigger bronchospasm so that warming fluids (from hand heat) may reduce complications (Gunderson & Stoeckle 1995). There may be individual cases where saline is indicated, but what those indications currently are remains unclear. Substantial research evidence is needed before saline instillation can be recommended. Nebulisation produces smaller droplets which should reach distal bronchioles, but Asmundsson et al. Hyperinflation Hyperinflation (‘bagging’, to loosen secretions) can be achieved with manual (‘rebreathe’) bags or through most modern ventilators (e. Muscle recoil following hyperinflation mimics the cough reflex and so loosens secretions. It also potentially ■ removal raises intrathoracic pressure ■ removal reduces cardiac return ■ causes (mechanical) vagal stimulation (resulting in bradycardia) ■ causes barotrauma. Manual rebreathe bags are available in various sizes; adult systems should include ■ pressure escape valves ■ oxygen reservoirs if patients normally receive high concentration oxygen ■ 2-litre bags (ideal hyperinflation volume is 1. Relative merits of manual and mechanical hyperinflation remain debated (Robson 1998), but ventilator-controlled hyperinflation leaves nurses’ hands free while ensuring hyperinflation volume is both controlled and measured (limiting barotrauma). Children’s tracheas are smaller and so where 1 mm of oedema might cause slight hoarseness in adults, it would obstruct three-quarters of a child’s airway (Marley 1998). Despite the frequency and long history of mechanical ventilation, many dilemmas of nursing management remain unresolved, influenced more by tradition or small-scale (often inhouse) studies than substantial research and meta- analysis. No aspect of airway management should be considered routine; as with all other aspects of care, frequent assessment enables the individualisation of care in order to meet the patient’s needs. Overviews are usually best obtained from books, but many articles usefully pursue aspects in detail. Wood (1998) provides an extensive literature review on dilemmas of endotracheal suction. Reviewing literature for developing departmental guidelines, McKelvie (1998) gives a reliable overview. Identify those effects that you have observed in your own clinical practice and those from the literature. Lighter sedation ■ enables patients to remain semiconscious, thus reducing psychoses while promoting autonomy ■ reduces hypotensive and cardioinhibitory effects caused by most sedatives Light sedation is a narrow margin between over- and under-sedation. The focus is therefore a nursing one rather than pharmacological, although some widely used sedatives are described. Neuromuscular blockade, once a common adjunct of sedation therapy, is also mentioned. Shelly (1998) stresses that comfort (in its widest sense) can be achieved through sedation. Sedation is now usually only necessary for ventilation if patients have: ■ tachypnoea, which will cause exhaustion ■ discomfort from artificial ventilation (usually from oral endotracheal tubes; also for brief procedures such as cardioversion and bronchoscopy). There are some specific pathologies, such as intracranial hypertension, where sedation is therapeutic. Some authors suggest that potential line displacement justifies sedation (Shelly 1994). Amnesia prevents recall of often horrific procedures, but inability to recall experiences, however horrific, may cause greater psychological trauma (Perrins et al. Prolonged benzodiazepine use causes receptor growth and down-regulation (tolerance), necessitating higher doses (Eddleston et al. Endorphins (endogenous opiates) contribute to sedative effects of critical illness. Midazolam is largely hepatically metabolised and renally excreted, so failure of these organs may cause accumulation of active metabolites (especially with older people, who usually have reduced renal clearance); causing unpredictable increases in half-life with critical illness (Bion & Oh 1997). Being relatively cheap, midazolam is still used by many units for prolonged sedation. Flumazenil’s effect is far shorter than benzodiazepines (half-life under one hour (Armstrong et al. Opiates Most opiates have sedative effects; as analgesia is usually necessary, this ‘side effect’ can be beneficial, provided it is remembered when assessing sedation. Opiates may become Sedation 51 the most important part of sedative regimes (Bion & Oh 1997). Morphine remains one of the most powerful opiates, but newer drugs, such as fentanyl, achieve rapid sedation with strong respiratory depression (which facilitates ventilation). Propofol Propofol’s lipid emulsion facilitates transfer across the blood-brain barrier, achieving rapid sedation. Inactivity of metabolites (Sherry 1997) and rapid redistribution into fatty tissue (Eddleston et al. Widely used for short- term sedation, Propofol is relatively expensive and so some units restrict use to circumstances where sedation is planned to last less than one day. Propofol depresses cerebral metabolism, thus reducing both cerebral oxygen consumption and intracranial pressure (Viney 1996).

Yet generic proscar 5 mg visa, in a for practice that integrates the dimensions of climate increasingly focused on economics buy proscar 5mg amex, it has economics and human caring 5 mg proscar visa. Consequently buy proscar 5 mg without a prescription, newer cost systems, such work and charitable religious organizations as managed care, do not look at human caring (Dolan, 1985). Prior to the establishment of or the nurse-patient relationship when allocating Medicare and Medicaid in 1965, the health-care resource dollars for reimbursement. Nursing Historically, nursing care delivery has not been students subsidized hospitals, and hospital-based financed or costed out in terms of reimbursement nursing care was not considered a reimbursable as a single entity. As nursing education As a result of the prospective payment system, moved away from the hospital setting to universi- hospital administrators were pressured to increase ties in the late 1950s and as the role of the student efficiency, reduce costs, and maintain quality. Research was con- the retrospective reimbursement of Medicare ducted in order to examine the costs associated and Medicaid in 1965 allowed for hospital prof- with nursing (Bargagliotti & Smith, 1985; Curtin, itability and the issue of nursing care costs was not 1983; McCormick, 1986; Walker, 1983). Hospital administrators were under process did not include the humanistic, caring considerable pressure to control costs. It Foshay (1988) investigated 20 registered nurses’ was assumed that the rising costs of health care perceptions of caring activities and the ability of were due to nurses’ salaries and the number of reg- patient classification systems to measure these car- istered nurses (Walker, 1983). Findings from this study revealed that a percent of hospital charges could not be identi- patient classification systems could not address the fied, because historically they had been tied to the emotional needs of patients, the needs of the eld- room rate. Specific car- care costs continued to rise and did not follow ing behaviors that could not be measured included traditional economic patterns. Cost-based reim- giving a reassuring presence, attentive listening, and bursement altered the forces of supply and de- providing information. In the traditional economic marketplace, Other research of this time period focused on when the price of a product or service goes up, the the cost and outcomes of all registered nurse demand decreases and consumers seek alternatives staffing patterns (Dahlen & Gregor, 1985; Glandon, at lower prices (Mansfield, 1991). However, in the Colbert, & Thomasma, 1989; Halloran, 1983; health-care marketplace, consumers did not seek Minyard, Wall, & Turner, 1986). These studies an alternative as the price of hospital-based care showed that nursing units staffed with more regis- continued to rise (DiVestea, 1985). This imbalance tered nurses had decreased costs per nursing diag- of the supply-and-demand curve occurred because nosis, increased patient satisfaction, and decreased consumers paid little out-of-pocket expense for length of stay. Government expenditure for the cost- Helt and Jelinek (1988) examined registered based reimbursement system was predicted to nurse staffing in five different hospitals over two bankrupt Social Security by 1985 unless changes years. It was shown that, al- Economic Implications though the acuity of hospitalized patients in- of Bureaucratic Caring creased, the average length of stay dropped from 9. Nursing produc- Theory: Research in tivity improved and quality of care scores increased Current Atmosphere with the increased registered nurse staffing. The of Health-Care Reform higher costs of employing registered nurses was off- set by the productivity gains, and the hospitals net- Investigation of the economic dimension of bu- ted an average of 55 percent productivity savings reaucratic caring is being explicated in part in nurs- (Helt & Jelinek, 1988). Findings from these research Hospital administrators had made budgeting studies have been valuable when linking the con- and operating decisions based on the undocu- cepts of politics, economics, caring, cost, and qual- mented belief that nursing care accounted for 30 ity in the new paradigm of health-care delivery. However, Although caring and economics may seem para- documented nursing research showed this assump- doxical, contemporary health-care concerns em- tion to be in error. A study conducted at Stanford phasize the importance of understanding the cost University Hospital found that actual nursing costs of caring in relation to quality. Similarly, the Ray (1981, 1987, 1989), Ray and Turkel (2000, Medicus Corporation funded a study in which data 2001, 2003), Turkel (1997, 2001), and Valentine were collected from 22 hospitals and 80,000 patient (1989, 1991, 1993) have examined the paradox be- records. Direct nursing care costs represented, tween the concepts of human caring and econom- on average, only 17. However, any bursement and operating room nursing costs, efforts to reshape the health-care system in our nursing represented only 11 percent of the total country must take into account the value of caring. Nyberg’s (1990) research findings indicated that By the time nursing researchers had demon- nurses were extremely frustrated over the economic strated the difficulty of costing out caring activities pressures of the past five years but that human care with patient classification systems and the effective- was present in nurses’ day-to-day practice. With the nurses see human care as their responsibility and introduction of managed care and increased corpo- goal. One ment was changing faster than nurse researchers nurse administrator proposed “caring as the mis- could document the impact of these changes on sion of the hospital with economic and manage- clinical practice. Although there were organiza- industry is now faced with a shortage of registered tional differences, results showed a high correlation nurses. According to statistics provided by the of caring attributes among the various settings. Department of Interviews conducted with nurses indicated a con- Health and Human Services (2000), over the next cern that their “ability to be caring was in jeopardy. These nurses felt that the practice these studies did not merge economic concepts into of caring was being seriously threatened by the nursing research or theory. As the nursing practice economic pressure associated with health-care environment has continued to change, new re- changes. Foa (1971), an ex- Narrative examples of the attribute, exchanging change theorist, designed an economic theory that commodity values, were “making caring tangible” and “patient care is a commodity (economic good could bridge the gap between economic and or value). In this model, noneco- gotiating the politics were “the nurse administrator nomic resources (love, status, and information) is a system coordinator, nurses are the system and were correlated with economic resources (money, know what impinges on them,” and “nurses are po- goods, and services). The philosophical framework of quality care is located in the reciprocal actions of the economic dimension of bureaucratic caring has the interpersonal nurse-patient relationship served in part as the basis for this type of needed (Hoggard-Green, 1995). Turkel (1997) interviewed nurses, ethnographic approach to study nurse-patient in- patients, and administrators from the for-profit teractions in the critical care environment. The sector to examine the process involved in the devel- subsequent theme generated among all categories opment of the nurse-patient relationship as an of interaction was the nurse-patient relationship. This research was conducted a qualitative study, Price (1993) examined the as managed care penetration was having an enor- meaning of quality nursing care from the perspec- mous impact on the current health-care delivery tive of parents of hospitalized children. The basic ing as a result of health-care reform and managed care, nurses are finding themselves in a period of transition, moving from traditional in-patient hos- The basic social process of the nurse- pital practice to community-based practice. In a re- patient relationship as an economic re- search study conducted by Turkel, Tappen, and Hall source was struggling to find a balance, (1999), the development of a positive nurse-patient which referred to sustaining the caring relationship was shown to be seen as a reward for ideal in a new reality controlled by costs. The research’s long-term goal qualitative interviews were accomplished in not- is to establish caring as an economic interpersonal for-profit and military sectors of the health-care resource. The purpose of this research was to through empirical nursing research, that hospitals continue the study of the nurse-patient relation- with a higher organizational caring score have in- ship as an economic interpersonal resource. Findings from this study identified that the nurse- patient relationship was both outcome and process. Categories, which emerged during data analysis, Economic/Political Implications included relationships, caring, and costs. The formal nomic dimension of bureaucratic caring can be theory of relational caring complexity illustrated used to guide administrative practice within that the caring relationship between the nurse, the health-care organizations. As a dimension of her patient, and the administrator is complex and research, Turkel (1997) interviewed eight top-level cocreative, is both process and outcome, and is hospital and corporate-level administrators to gain a function of a set of economic variables and a an understanding of how they viewed the experi- set of nurse-patient relational caring variables. Economic variables are depicted as time, technical, Administrators were chosen to be interviewed be- and organizational resources. Nurse-patient rela- cause they make the ultimate decision on how to al- tional caring variables are caring, relationships, and locate scarce human and economic resources education (Turkel & Ray, 2000).

Other studies coming from the same perspective have asked subjects to mark either two ends of a life-size piece of paper (Gleghorn et al cheap proscar 5 mg. This research has consistently shown that individuals with clinically defined eating disorders show greater perceptual distortion than non-clinical subjects cheap proscar 5 mg otc. However purchase proscar 5mg free shipping, the research has also shown that the vast majority of women generic proscar 5mg on line, with or without an eating disorder, think that they are fatter than they actually are. Some research has emphasized a discrepancy between perceptions of reality versus those of an ideal without a comparison to the individual’s actual size as objectively measured by the researcher. This research has tended to use whole-body silhouette pictures of varying sizes whereby the subject is asked to state which one is closest to how they look now and which one best illustrates how they would like to look. It has consistently been shown that most girls and women would like to be thinner than they are and most males would like to be either the same or larger (see Figure 6. The final and most frequent way in which body dissatisfaction is understood is simply in terms of negative feelings and cognitions towards the body. This has been assessed using questionnaires such as the body shape questionnaire (Cooper et al. These questionnaires ask questions such as ‘Do you worry about parts of your body being too big? Therefore, body dissatisfaction can be conceptualized as either a discrepancy between individuals’ perception of their body size and their real body size, a discrepancy between their perception of their actual size as compared with their ideal size, or simply as feelings of discontent with the body’s size and shape. However, whichever conceptualization is used and whichever measurement tool is chosen to operationalize body dissatisfaction it seems clear that it is a common phenomenon and certainly not one that is limited to those few individuals with clinically defined eating disorders. In addition, research has explored the role of psychological factors that may translate the social factors into actual body dissatisfaction. Magazines, newspapers, television, films and even novels predominantly use images of thin women. These women may be advertising body size related items such as food and clothes or neutral items, such as vacuum cleaners and wallpaper, but they are always thin. Alternatively, they may be characters in a story or simply passers-by who illustrate the real world, but this real world is always represented by thinness. Whatever their role and wherever their existence women used by the media are generally thin and we are therefore led to believe that thinness is not only the desired norm but also the actual norm. When, on those rare occasions a fatter woman appears she is usually there making a statement about being fat (fat comedians make jokes about chocolate cake and fat actresses are either evil or unhappy) not simply as a normal woman. For example, Ogden and Mundray (1996) asked men and women to rate their body dissatisfaction both before and after studying pictures of either fat or thin men or women (the pictures were matched in gender to the participant). The results showed that all participants, regardless of sex, felt more body satisfied after studying the fatter pictures and more body dissatisfied after studying the thinner pictures. If such changes in body dissatisfaction can occur after only acute exposure to these images then it is possible that longer-term exposure might be more serious. Ethnicity Although body dissatisfaction has predominantly been seen as a problem for white women, the literature examining the relationship between body dissatisfaction and ethnic group is contradictory. For example, higher rates of a range of behaviours associated with body dissatisfaction have been found in white women when compared with black and/or Asian women in terms of bulimic behaviours (Gray et al. However, in direct contrast, other studies report the reverse relationship between ethnicity and weight concern. Furthermore, additional studies have suggested that equally high levels of weight concern can be found in women and girls regardless of their ethnicity (Dolan et al. Therefore, some research indicates that whites are more body dissatisfied than Asians and blacks, other research shows that whites are less dissatisfied and some research even shows that there is no difference by ethnic group. Social class Body dissatisfaction is also generally believed to be a problem for the higher classes. Several studies in this area indicate that factors ranging from body dissatisfaction, body distortion, dieting behaviour to eating disorders are more prevalent in higher class individuals. Similar results have also been reported for the prevalence of anorexia nervosa (Crisp et al. However, research also suggests that the relationship between social class and weight concern is not straightforward. Similar results were reported by Eisler and Szmukler (1985), who examined abnormal eating attitudes. Fur- thermore, additional studies report that social class is unrelated to factors such as body dissatisfaction, the desire for thinness, the desire for weight loss and symptoms indicative of eating disorders (Cole and Edelmann 1988; Whitaker et al. Therefore, although social class is believed to be a cause of body dissatisfaction, the results remain unclear. The family Research has also focused on the impact of the family on predicting body dissatis- faction. In particular, it has highlighted a role for the mother and suggested that mothers who are dissatisfied with their own bodies communicate this to their daughters which results in the daughters’ own body dissatisfaction. For example, Hall and Brown (1982) reported that mothers of girls with anorexia show greater body dissatisfaction than mothers of non-disordered girls. However, research examining concordance between mothers and daughters has not always produced consistent results. For example, Attie and Brooks-Gunn (1989) reported that mothers’ levels of compulsive eating and body image could not predict these factors in their daughters. Likewise, Ogden and Elder (1998) reported discordance between mothers’ and daughters’ weight concern in both Asian and white families. Therefore, research exploring the role of social factors has highlighted a role for the media, ethnicity, social class and the mother’s own body dissatisfaction. First, much of the evidence is contradictory and therefore straightforward conclusions are problematic. Secondly, even if there was a relationship between social factors and body dissatisfaction, simply looking for group differences (i. Perhaps, simply looking for group differences hides the effect of other psychological causes. From this perspective, ethnicity may relate to body dissatisfaction, but only when ethnicity is also accompanied by a particular set of beliefs. Similarly, it may not be class per se that is important but whether class reflects the way an individual thinks. Research has explored the role of beliefs, the mother–daughter relationship and the central role of control. Beliefs Some research has examined the beliefs held by the individuals themselves and their family members. For example, when attempting to understand ethnicity, studies have highlighted a role for beliefs about competitiveness, the value of achievement, material success and a parental belief that the child is their future (Ogden and Chanana 1998). In addition, the literature has also emphasized beliefs about a woman’s role within society. In a similar vein, when attempting to explain the role of social class research has highlighted a role for beliefs about achievement and it has been suggested that eating disorders may be a response to such pressures (Bruch 1974; Kalucy et al. Lower class individuals, in contrast, may aspire more in terms of family life and having children, which may be protective against weight concern. Cole and Edelmann (1988) empirically tested this possibility and assessed the relationship between the need to achieve and eating behaviour.

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