My Auto/Ethnographic Dilemma: Who Owns the Story?

This article explores ethical issues of co-mingled data, demarcating the field and informed consent in a study researching the consequences of Christian fundamentalist ideology on the lives of “Bible Belt gays”. When what constitutes informed consent is ambiguous, how does the qualitative researcher justify her decision either to include or exclude meaningful data? To illustrate these ethical issues, I analyze four instances of co-mingled data, two featuring Christian fundamentalists and two Bible Belt gays, in which I gain theoretical insights under conditions of blurry consent, and weigh potential harm to subjects against the liberatory goals of the project.     

Bring back orphanages—An alternative to foster care?

The current foster care system in America has not been successful in transitioning youth who are in the system to become productive, independent adults in today's society. Study after study cites the poor adjustment of foster care youth in school settings because of constant change in foster care placements and the corresponding poor achievement of these students. We find many of the youth needing public aide, working at low-paying jobs (if working at all), often caught up in the criminal corrections system, and homeless. Having had no permanent home and very often lacking positive role models, these children have little opportunity to build a solid foundation that might give them the chance to succeed.In addition, the current foster care system has in place short-term home placements, and this system is failing. What is needed are long-term placements for these children-placements that last until adulthood. What we are suggesting is that we as a society consider bringing back orphanages-wellrun facilities that provide a stable environment over time, good educational opportunities, and the chance for the children to develop emotionally in a secure, nurturing environment such as those found at Boys Town, the Hershey School, Kinderhaus and The SEED Foundation.     

An Extended Mixture Distribution Survival Tree for Patient Pathway Prognostication

Mixture distribution survival trees are constructed by approximating different nodes in the tree by distinct types of mixture distributions to improve within node homogeneity. Previously, we proposed a mixture distribution survival tree-based method for determining clinically meaningful patient groups from a given dataset of patients’ length of stay. This article extends this approach to examine the interrelationship between length of stay in hospital, outcome measures, and other covariates. We describe an application of this approach to patient pathway and examine the relationship between length of stay in hospital and/or treatment outcome using five-years’ retrospective data of stroke patients.     

Therapeutic alliance and treatment progress in couple psychotherapy

This study examined the ability of the therapeutic alliance to predict treatment progress on individual- and relationship-level variables from the early to middle phase of couple treatment. Although alliance did not predict progress in individual functioning, it accounted for 5-22% of the variance in improvement in marital distress. Women's mid-treatment alliance uniquely predicted improvement in marital distress, over and above early treatment alliance. When men's alliances with the therapist were stronger than their partners' at session 8, couples showed more improvement in marital distress. Treatment response was also positively associated with women's ratings of their partners' alliance. Results confirm that the therapeutic alliance in conjoint treatment is composed of distinct client subsystems that are useful predictors of treatment progress.     

Changes in couple,parenting, and individual functioning following Family Expectations program participation

The current study investigated changes in couple, parenting, and individual functioning following participation in Family Expectations, a relationship and parenting education program for new or expectant parents. The sample comprised 339 couples who participated in most sessions of the Family Expectations program and completed assessments at three different time points over a 12-month period. Study analyses examined: (a) change shortly following completion of the program, (b) associations between short-term change and subsequent change in outcomes at 12-month follow-up, and (c) differences in short-term change between married and unmarried couples. Significant improvements were observed in all three domains at short-term follow-up. Short-term changes, particularly for psychological distress, were predictive of long-term change in multiple domains. Few moderation effects by marital status were evident; those that appeared suggested stronger effects for married participants compared to unmarried. Study findings inform ongoing discussions into the utility of federally-funded relationship and parenting programming.     

On-shift and daily variations in self-report and performance measures in rotating-shift and permanent night nurses

Abstract

An intensive study was conducted of the influence of type of shift system, type of shift, and time-into-shift on a battery of on-shift and daily measures obtained from 61 female nurses over a 28-day period. Thirty-two rotating-shift nurses and 28 permanent night nurses recorded data on a hand-held computer at the start and end of each day, and every 2-h during their shifts. The measures included a sleep diary, self-ratings of mood, workload, and personal disruption, and two cognitive performance tasks. These results suggest that the permanent night nurses were no worse off and for some measures were actually better off than the rotating-shift nurses after controlling for differences in age and shiftwork experience; the night-shift was problematic for the rotating-shift nurses but so was the early shift; mood deteriorated and reaction time got slower over the course of the night-shift but extra long responses (which may correspond to lapses of attention) and rated workload were lower on the night-shift. The relatively large number of consecutive night-shifts worked by the rotating-shift nurses, the uneven distribution of workload between shifts, and the long night-shift may have contributed to these results.     

Determinants and Long‐Term Effects of Attendance Levels in a Marital Enrichment Program for African American Couples

Although most efficacious marital enrichment programs are multisession, few studies have explored whether outcomes differ according to session attendance, particularly among minority groups with lower than average participation in prevention programs. This study therefore investigates attendance levels and long‐term improvements in couple functioning among 164 couples participating in the Promoting Strong African American Families program. Structural equation models indicated session attendance predicted 2‐year changes for men's reports of communication, commitment, and spousal support (marginally) but not for women's. Individual and couple characteristics that predicted attendance levels were also identified. Results highlight distinct gender differences in the effects of sustained attendance as well as characteristics that provide early identifiers for African American couples at increased risk of low program attendance.     

A Multistate Transition Model for Osteoarthritis Pain Change

Pain severity of knees is assessed using an ordinal scale in patients with musculoskeletal diseases and often changes over time. Assessment of the effect of a particular risk factor on the change in pain severity will shed light on our understanding of biological mechanisms and provide guidance for rational clinical intervention for recurrent pain. The multistate transition model allows transitions between several different states of pain severity and estimates the transitional intensity using an extension of the Cox proportional hazards model. Using data from a longitudinal study, we applied this model to assess the relation of two psychological factors to the change in knee pain severity over time among patients with osteoarthritis and demonstrated that the multistate transition model can be a valuable tool for rheumatic disease studies.     

Access to Health Care: Social Determinants of Preventive Cancer Screening Use in Northern British Columbia

The purpose of this study was to examine theextent to which social factors are influentialin determining women's access to cancerscreening services in Prince George, BritishColumbia. Specifically, this study evaluatedthe association of age, income, education, workstatus, disability, marital status, andimmigrant status with previous use of screeningmammography and Pap tests. Data was obtainedfrom the 1994 National Population HealthSurvey, which contains a sample of 416 womenfrom the Prince George area. A series oflogistic regression analyses were used todistinguish ever versus never beenscreened as well as recency of previousscreening. Participation rates in screeningmammography in Prince George are comparativelyhigh; however, no association was found betweensocial factors and previous mammography use.This suggests women in Prince George areparticipating in mammography servicesregardless of social background. Participationrates in Pap test screening in Prince Georgeare high and are similar to provincialaverages; however, while a large percentage ofwomen have been screened, this percentagevaries across social groups. Immigrant women,single women, and women with less education areover represented among women who have never hada Pap test. In addition, older women are lesslikely to obtain a recent Pap test whencompared to younger women. This study suggeststhat certain groups of women in northernBritish Columbia experience low participationin health services, resulting in a higher riskfor poor health and a poor quality of life.