The certainty of judgments in health evaluations

Most evaluators seem to presume that all evaluative studies should result in conclusive evidence. Often, however, less than conclusive evidence may not only suffice, but be the only real alternative under conditions of limited evaluation resources. Three levels of evidence common to evaluation studies are discussed: suggestive evidence, preponderant evidence, and conclusive evidence. Ten factors are also presented which can be used to determine the level of certainty appropriate for a given evaluation study. Consideration of these factors enables the evaluator to specify when less than conclusive evidence is acceptable.     

The healing power of dogs: Cocoa's story

Animals bring a sense of "at homeness" and even normalcy to people who are hospitalized or live in health care facilities. Illnesses, separation from family, fear, loneliness, and even depression may be lessened for those who receive a therapy dog visit by providing a welcome change in routine and something to look forward to. Individuals are often more active and responsive during and after a visit. Just stroking and petting a dog requires the use of hands and arms, as well as the motions of stretching and turning. Dogs are also unconcerned with age or physical ability; they accept people as they are. This alone causes many to reach out and interact with dogs. Animals provide a focus for conversation and a common interest. As Cocoa's human partner can attest, a pet also makes it easier for strangers to talk. Cocoa is known by so many people at the facilities she visits that residents' family members often stop to talk with "Cocoa's mom" when they meet her in the community, asking questions about how Cocoa is doing. When Cocoa is no longer able to perform her services, many in her community will mourn. Cocoa's story, as well as the limited research literature, supports the positive physical and psychological effects of animals, but continued research on the effect of therapy animals on health outcomes is needed. As advocates for clients, nurses are in key positions to facilitate the inclusion of animals in clients' care. Although not for everyone, including those who react negatively to animals or who are allergic, pet therapy offers important possibilities for providing holistic care that extends not only to clients, but also to family members and staff, and to the pets themselves.     

Characteristics of Older Adult Problem Gamblers Calling a Gambling Helpline

Background Few investigations have characterized groups of older adults with gambling problems, and published reports are currently limited by small samples of older adult problem gamblers. Gambling helplines represent a widespread mechanism for assisting problem gamblers to move into treatment settings. Given data from older adult problem gamblers in treatment, we hypothesized that older as compared with younger adult problem gamblers calling a gambling helpline would be less likely to report gambling-related problems.Design and methods Logistic regression analyses were performed on data obtained from January 1, 2000 to December 31, 2001, inclusive, from callers with gambling problems (N = 1,084) contacting the Connecticut Council on Problem Gambling Helpline.Results Of the 1,018 phone calls used in the logistic regression analyses, 168 (16.5%) were from older adults and 850 (83.5%) from younger adults. Age-related differences were observed in demographic features, types and patterns of gambling reported as problematic, gambling-related problems and psychiatric symptoms, substance use problems, patterns of indebtedness, and family histories of addictive disorders. Older as compared with younger adult problem gamblers were more likely to report having lower incomes, longer durations of gambling, fewer types of problematic gambling, and problems with casino slot machine gambling and less likely to report gambling-related anxiety, family problems, illegal behaviors and arrests, drug problems, indebtedness to bookies or acquaintances, family histories of drug abuse, and problems with casino table gambling.Conclusions Older as compared with younger adult problem gamblers calling a gambling helpline differ on many clinically relevant features. The findings suggest the need for improved and unique prevention and treatment strategies for older adults with gambling problems.     

Social Security and SSI as safety nets for the elderly poor

Partial privatization of Social Security is being considered as an integral part of the future Social Security program for American retirees. Because privatization creates uncertainty about the amount of retirement income that future retirees may expect to receive, the issue of a safety net is critical. This article presents the findings from an empirical study that investigated the degree to which the current Social Security and Supplemental Security Income (SSI) programs provide a safety net, separately and in combination, to the elderly poor. The major findings were that the Social Security program not only increases the income statuses of both posttransfer and pretransfer poor elderly people considerably, but that the program also significantly equalizes the distribution of income among them. In addition, the SSI program supplements the Social Security program in establishing an even greater safety net, especially for posttransfer poor elderly people. On the other hand, Social Security benefits make the income disparity among races greater between both posttransfer and pretransfer poor elderly people. Implications for policy are discussed.     

Aspects of guilt and self-reported substance use in adolescence

The use of addictive substances is undergoing moralization in American society-behaviors once viewed as personal preferences now carry moral significance. Research has shown that sociomoral emotions like guilt, thought to be reflective of one's internalized standards and societal mores, can be an important influence on behavior. The present study explored the relationship between college students' self-reports of adolescent substance use (cigarettes, alcohol, and marijuana) and scores on indices tapping different aspects of guilt (Standards, Situational, and Chronic Guilt). Participants were 230 undergraduate students (mean age = 19; 55 percent female; 69 percent White). Substance users had lower scores on Standards and Situational Guilt than non-users, but no difference was observed in Chronic Guilt. The present results suggest that a stronger internalization of societal standards, as reflected by higher scores on Standards and Situational Guilt, may prove a useful tool in the prevention of substance use.     

THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

Evaluation of an upper extremity student-role functioning scale using item response theory

Millions of workers suffer from upper extremity (musculoskeletal) disorders. Many of these workers are predisposed to upper extremity musculoskeletal disorders because of early exposure to ergonomic risks as students. Computer usage for four or more hours remains the greatest risk for upper extremity musculoskeletal disorders for workers and students alike. Developing preventative methods to reduce student exposure, and thus protect future workers from upper extremity musculoskeletal disorders later in life, requires an appropriate measure for upper extremity musculoskeletal disorder prevalence and related limitations for student functioning. Item response theory analysis was used to evaluate and further develop a upper extremity functioning scale for the student role.