Adapting enactments to couple reactivity: five developmental stages

Interest in change interventions that are common to different models of relationship therapy has spurred investigation of enactments as one such candidate. In change-focused enactments, therapists structure and coach couple/family interaction, as opposed to channeling interaction through the therapist. Still, varying levels of couple/family distress, volatility, and reactivity mean that readiness for enactment intervention varies along a broad continuum and changes over the course of therapy. This suggests the need for differentiated enactments. Currently, however, no model exists for adapting enactments to changing relationship conditions. We propose a five-stage developmental model of clinical operations in couple therapy that adapts the process and structure of enactments to changing levels of relationship distress, interactional volatility, and emotional reactivity. The model increases the possibility for therapists to use enactments successfully over the entire course of couple therapy. Issues to be considered in using the couple enactments model as a template for the development of enactment models for other relationship systems are noted.     

Think they're drunk? Alcohol servers and the identification of intoxication

Despite alcohol server training programs and legal liability aimed at controlling intoxication, server intervention appears to be rare. Given the difficulty in assessing intoxication, it can be assumed that improvement in assessment skills would increase the likelihood of intervention. Unfortunately, little is known regarding practices servers use to identify intoxication. In order to build a more informed base for policy formation and server training, the focus of this inquiry was to examine practices used by servers to assess intoxication. The analysis was based upon questionnaires mailed to a random probability sample of licensed servers from one state (N = 822). Indicators found to be most important were examined in relation to a variety of occupational characteristics. Implications for training curricula, policy formation, and future research are discussed.     

Providers' perceptions of how rural consumers access and use mental health services

This article describes the third phase of a research study undertaken within a Canadian provincial regional health authority to explore and analyze mental health services and other resources used by rural consumers after discharge from inpatient mental health programs. The focus of this article is the qualitative research findings obtained from mental health service providers and members of allied agencies. This article will discuss the literature on rural consumers' access and use of mental health programs and services; describe the context and method used to conduct the focus groups with rural service providers; characterize access and use problems from the service providers' perspectives; and suggest strategies to address these problems.     

More harm than good? Diagnostic codes for child and adult abuse

This study sought to understand the reasons for the lack of use of ICD diagnostic codes for child and adult abuse. New Jersey professionals were recruited to participate in three focus groups on child abuse, adult or primarily woman abuse, and elder abuse. Participants included health care providers, advocates from the community, and representatives of state agencies and the insurance industry. Concerns about coding abuse included further jeopardizing victims/patients, diagnostic uncertainty, and lack of resources. Members of the child abuse group were somewhat more receptive to coding abuse. Reasons to code, such as for documentation and reimbursement were discussed and rebutted. Most participants concluded that use of the abuse codes should be judicious because they have the potential to do more harm than good. More research is needed on the implications of coding for victims/patients along with medical education in the identification of abuse in general and coding abuse in particular.     

Role of workplace safety: a revisit of the relationship between job satisfaction and employment status

This study evaluated the relationship between employment status (i.e., part- and full-time) and job satisfaction, with the focus on the moderating roles of perceived injury risk and injury incidence. The results found that the level of job satisfaction for full-time workers was about the same regardless of the level of injury risk they perceived. In contrast, job satisfaction of part-time workers was significantly higher when they perceived low injury risk rather than high injury risk. The findings also supported the potential adverse impact of injury incidence and injury risk on job satisfaction for both part- and full-time workers. This study highlighted the importance of understanding both workplace safety and job satisfaction when attempting to understand the differences between part-time and full-time workers.     

Definition and Measurement of Chasing in Off-Course Betting and Gaming Machine Play

The attempt to recover gambling losses by continuing to gamble (chasing) has featured prominently in accounts of excessive gambling. This research represents the first attempt to operationalize and measure chasing in terms of its cognitive (behavioral intention), emotive (urges) and behavioral components, and to investigate the role of chasing in relation to impaired control over gambling. Two survey samples of 84 male off-course (betting shop) race gamblers (mean age 41, SD = 15) and 137 gaming machine players (73 females, mean age 48, SD = 15 and 64 males, mean age 43, SD = 16) were recruited at gambling venues. Respondents completed a structured questionnaire that investigated retrospective report of chasing and an impaired control scale (The Scale of Gambling Choices). It was found that the various components of chasing formed a composite measure with high internal reliability that was strongly related to indicators of excessive gambling (e.g. time spent gambling, expenditure as a proportion of income) and to impaired control scores. Reacting to large wins by further betting was almost as strongly related to impaired control as was persistence after losing. Those who returned later to chase had significantly higher impaired control scores than those who only chased within a session. Alcohol-related chasing was associated with impaired control over gambling. Chasing of losses and impaired control appear to be generic processes in evidence across both forms of gambling and gender (most format and sex differences were of minor significance).     

Vitamin B1 blocks damage caused by hyperglycemia

Diabetes accelerates the aging process and leads to complications that include blindness, renal failure, nerve damage, stroke, and cardiovascular disease. It has been hypothesized that high plasma glucose concentrations are responsible for increased mitochondrial free radical production and subsequent inactivation of glyceraldehyde phosphate dehydrogenase (GAPDH) in vascular endothelial cells and other cells implicated in these complications. As a result of the decreased ability of GAPDH to process upstream metabolites, three pathways of metabolic damage are activated, which include the advanced glycation end-product formation pathway, the protein kinase C pathway, and the hexosamine pathway. All three pathways have been implicated in abnormal cell signaling in diabetes. A group of German and U.S. scientists has now found that treating diabetic rats with high doses of benfotiamine, a lipid-soluble form of vitamin B1, can prevent diabetic retinopathy and all three forms of metabolic damage by stimulating transketolase activity and thus diverting excess metabolites toward the pentose pathway. Although vitamin B1 is available over the counter, the researchers at this time do not advocate self-treatment without further clinical data.     

Experience of cumulative trauma disorders on life roles of worker and family member: a case study of a married couple

The prevalence of diagnosed cumulative trauma disorders (CTD) within the workforce comes at a high price for employers burdened with financial losses from missed work and worker's compensation costs. Research has focused primarily on the impact of CTD on the worker role within the workplace, overlooking the impact on roles across multiple environments [24,35,54]. Furthermore, the influence of CTD on life roles of a spouse has not been examined. This single case study illustrated the experience of CTD within a marital relationship through the use of grounded theory. Results indicated that adaptations to CTD symptoms were least altering to the established routines and roles of the couple. With progression of symptoms, the spouse without symptoms was relied on more heavily for adaptations to manage pain. The results of this study indicate that occupational therapists must examine the client's valued roles and incorporate the family into intervention strategies.     

Pretest-posttest designs and measurement of change

The article examines issues involved in comparing groups and measuring change with pretest and posttest data. Different pretest-posttest designs are presented in a manner that can help rehabilitation professionals to better understand and determine effects resulting from selected interventions. The reliability of gain scores in pretest-posttest measurement is also discussed in the context of rehabilitation research and practice.     

Huntington's disease

In this case study, we describe the symptoms, neurological exam, neuropsychological test results, and brain pathology of a man who died with Huntington's disease (HD). HD is a rare neurodegenerative disease. Like other movement disorders involving the basal ganglia, HD affects motor, cognitive, and psychiatric functioning. The disease follows an autosomal dominant pattern of inheritance, with onset of symptoms most commonly occurring in the late 30s or early 40s, as in this patient. HD is caused by an unstable expansion of the trinucleotide CAG, coding for glutamine, on chromosome 4. Despite knowledge of the gene mutation responsible for HD, no definitive treatment is currently available to slow or halt progression of the disease. However, symptomatic treatment can significantly improve the quality of life for patients with HD.