Beyond Clinical Complexity: Nonmedical Barriers to Nursing Home Care for Rural Residents

We conducted a qualitative content analysis of barriers to nursing home admission for rural residents. Data came from semi-structured interviews with 23 rural hospital discharge planners across five states (Georgia, Idaho, Minnesota, Pennsylvania, and Wisconsin). From those, we identified four themes around nonmedical barriers to rural nursing home placement with particular salience in rural areas: financial issues, transportation, nursing home availability and infrastructure, and timeliness. We also identified policy and programmatic interventions across four themes: loosen bureaucratic requirements, improve communication between facilities, increase rural long-term care capacity, and address underlying social determinants of health.     

Parent–Caregiver Experiences With the Autism Spectrum Disorder Service Delivery System

Autism spectrum disorder (ASD) diagnoses are increasing, leading to growing demands on the service delivery system to meet the needs of children and families. Further understanding individual enabling components such as perceptions of parents/caregivers and personnel, as well as community-level enabling components such as the availability of and quality of services, may help inform system improvements. In this qualitative study, 19 parents/caregivers of children with ASD in one state in the United States were interviewed regarding their experiences with the ASD service delivery system, as well as their individual responses in relation to these experiences. Emergent themes point to the importance of individual coping strategies such as social support, collaboration with service providers, advocacy and empowerment, determination, and luck. Characteristics of the service delivery system, positive and negative, also were described. Findings can inform the design of future programs, services, and policies to support parent/caregiver coping and improved service delivery.     

Happily Ever After? The Journey From Foster Care to Adoption

Providing the foster child with a forever family through adoption is often seen as a happy ending to the long and painful journey through foster care. This qualitative study explores this complex journey from foster care to adoption from the perspective of 30 young adults aged 18 to 25 who were adopted from the foster care system after the age of 8. The results indicate that the foster and adoption experience for these youth cannot be compartmentalized when trying to understand the impact adoption has had on their overall sense of self. Implications for future research to explore the emerging concept of foster/adoptive identity for older youth adopted through the foster care system are provided.     

Adding to the controversy: Pitfalls in the diagnosis of testosterone deficiency syndromes with questionnaires and biochemistry

Purpose. To determine the value of available questionnaires used for the diagnosis of testosterone deficiency syndromes (TDS) by correlating their ratings with a panel of hormonal determinations in a male population.

Materials and methods. Participants completed the ADAM questionnaire and underwent biochemical evaluation at the local site. Assessments determined entry into Group A (symptomatic) or Group B (non-symptomatic). After stratification, subjects provided a morning sample of blood, completed the Aging Male Survey (AMS) and the newly developed Canadian Society for the Study of the Aging Male (CSAM-Q) questionnaires. Serum aliquots were analysed at a central lab for 8 putative markers commonly associated with symptomatic testosterone deficiency associated with aging: total testosterone (T); bioavailable T (BT); dehydroepiandrosterone sulphate (DHEA-S); sex-hormone binding globulin (SHBG); luteinizing hormone (LH), prolactin (PRL); thyroid-stimulating hormone (TSH) and insulin-like growth factor-1 (IGF-1).

Results. 92 men were screened; of these 59 (mean age of 58 ± 11 years) completed the study, 30 (51%) scored positively (mean 61.5 years) to the ADAM while 29 (49%) did not (mean 54.1 years). For the AMS the weight of the three domains (psychological, somato-vegetative and sexual) was significantly greater in Group A (p < 0.001) than in Group B. Equally, for the CAS questionnaire, the scores for the variables energy, global performance, frequency of intercourse, mood and quality of sleep were lower in Group A than in their asymptomatic counterparts (p < 0.001). The domain of memory assessment within the CSSAM-Q was not discriminatory. ADAM and AMS are self-administered and completed within 10 minutes. CSSAM-Q is more time consuming, requires an investigator to administer, and memory domain is biased in favour of specific professional training.

No difference was found between the two groups in 6 of 8 biochemical tests. However, significant lower values (p < 0.001) were found for DHEA-S and IGF-1 in the symptomatic group as compared with the non-symptomatic cohort.

Conclusions. This study confirms that newer, more complex tools perform similarly to the simpler ADAM questionnaire. The lack of correlation between the clinical picture and the most commonly used biochemical confirmatory tests, again, clearly points to the paramount importance of the clinical evaluation. An emphasis and reliance on serum T alone hinders the clinician's ability to manage testosterone deficiency syndromes (TDS).     

Young Adolescents' Patterns of Involvement with Siblings and Friends

We identified different patterns in young adolescents' experiences with their siblings and their friends and investigated the connections between these relationship patterns and both young adolescents' psychosocial functioning and the characteristics of their family and neighbourhood contexts. Participants were 141 families, including mothers, fathers, young adolescents (M = 11.4 years), and their younger siblings (M = 8.3 years). Cluster analysis revealed three groups of young adolescents: (1) high intimacy and involvement with sibling, high intimacy with friend but low involvement with friends ('Differentiated'); (2) high intimacy and involvement with friend but not sibling ('Incongruent'); and (3) low involvement and intimacy with both sibling and friend ('Congruent'). The Congruent pattern was associated with young adolescents' personal characteristics and their parent-adolescent relationship experiences. In contrast, the Incongruent and Differentiated profiles were linked to contextual factors (i.e., family and neighbourhood resources). Findings suggest that individual differences exist in the associations between young adolescents' relationships with siblings and friends.     

Career Counseling With Persons Living With HIV: An Ecological Approach

Advances in medical treatment have greatly extended the life span and quality of life of persons living with HIV, with the nature of the disease evolving from causing an early death to chronic, manageable illness. Career counselors will increasingly be called upon to assist persons living with HIV. This article provides an overview of HIV disease and of career‐related issues unique to persons living with HIV. Career counseling interventions are discussed from an ecological perspective.     

Marketing Theory Matters

There have been concerns about the slow pace of theory development inside and outside of marketing for a number of years. Rarely have some of the possible reasons for this lack of development been considered, or an assessment of the ways in which a more theoretically driven focus might emerge been discussed. This paper addresses these gaps in the current debate. Potential difficulties have emerged as a result of a lack of theorists, lack of theory courses, business school strategies and misguided perceptions of practitioner-oriented research amongst other things. Suggestions for future action to drive a more theoretically driven marketing are proposed.     

Contraceptive Method Choice Among Youth in the United States: The Importance of Relationship Context

We examine the relationship characteristics associated with contraceptive method choice within young people’s nonmarital sexual relationships, using data from retrospective relationship histories available in the third wave (2001–2002) of the National Longitudinal Study of Adolescent Health. Data-reduction techniques produce a detailed multidimensional characterization of relationship commitment for nonmarital sexual relationships. We then use multilevel analysis to estimate associations between two key relationship characteristics—relationship commitment and couple heterogamy—and the type of contraceptive method used at last sexual intercourse within each relationship. Results indicate that for a given individual, contraceptive method choice varies across relationships as a function of these characteristics, even after we account for important individual and family characteristics and prior relationship experiences.     

Examining the role of parental factors on depression among Urban African American youth living in public housing

This study examined the potential risk and protective parental factors associated with depression among African American youth living in public housing. Utilizing a community-based participatory research approach, 239 African-American youth surveys were collected during 2013–2014 in two urban public housing developments with low socioeconomic profiles. Over half (52.3%) of the sample was in high school and female (58%). 65.3% reported living with their mother while 38% reported being employed. Bivariate analysis revealed significant correlations between depression and maternal substance abuse, paternal monitoring, parent-child relationship, and family time. Results from the regression analyses indicated that higher depression scores were significantly associated with youth who reported poor parent-child relationships, low levels of paternal supervision and high levels of maternal drug abuse. These findings provide support for claims about the importance of parent-child relationship and paternal monitoring as a protective factor for depressive symptoms, particularly during adolescence. Moreover, findings suggest that interventions which are targeted towards urban African American youth should address parental factors as a pathway to decrease depression among this population.     

Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives

While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre‐intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in ‘real‐world’ settings.