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.     

Public opinion and the privatization of welfare: some theoretical implications

The social policy of the Thatcher government is characterized by an abrupt shift in the direction of the private sector. To what extent does this reflect what people want? The Institute of Economic Affairs conclude from the only suitable national opinion survey that such a move is strongly supported. Our reanalysis of their data shows that this strand in public opinion can coexist with, and need not contradict, an equal public enthusiasm for state welfare. Such results have important implications for our understanding of social policy. We conclude, therefore, with a discussion of contrasting marxist and liberal accounts which seeks to show that the evidence of ambivalence in popular attitudes about the welfare state supports particular developments in theory.     

The Role of Shocks in Employee Turnover*

This paper reports the findings from a recent study of nurse leavers at eight large hospitals in the National Health Service (NHS) of England and Wales. The study develops and extends an influential theory of employee turnover by describing how for some leavers a single, jarring event or shock triggers the decision to quit. By elaborating on the nature of shocks for this sample of 352 nurse leavers, the paper allows for improved understanding of nursing turnover and thus offers an example of relevant management research. The analysis of shock illustrates how conventional research methodologies can lead to a distorted picture of turnover. This has wider implications, both for any organization wishing to manage turnover effectively and for future research. The paper adds to the limited body of empirical analysis on actual leavers, thereby contributing to an ongoing methodological debate concerning the use of proxy variables. By highlighting flaws in the dominant methodology used to study turnover, the paper offers an example of management research that is also rigorous, and thus ‘pragmatic’.     

Internalized Other Interviewing in Relational Therapy: Three Discursive Approaches to Understanding its Use and Outcomes

For over 20 years, family therapist Karl Tomm has been engaging families and couples with a therapeutic intervention he calls Internalized Other Interviewing (IOI). The IOI (cf. Emmerson‐Whyte, 2010; Hurley, 2006) entails interviewing clients, from the personal experiences of partners and family members as an internalized other. The IOI is based on the idea that through dialogues over time, one can internalize a sense of one's conversational partner responsiveness in reliably anticipated ways. Anyone who has thought in a conversation with a family member or partner, “Oh there s/he goes again,” or anticipates next words before they leave the other's mouth, has a sense of what we are calling an internalized other. For Tomm, the internalized anticipations partners and family members may have offers entry points into new dialogues with therapeutic potential—particularly, when their actual dialogues get stuck in dispreferred patterns.     

Maternal Discipline and Children's Adjustment: The Role of the Cultural and Situational Context

This study examined how the cultural and situational contexts can jointly shape the consequences of discipline strategies. Israeli mothers who grew up in Israel or in the Former Soviet Union (FSU) (overall N = 110) reported regarding their use of psychologically controlling and punitive discipline with their seven‐years‐old to 10‐years‐old children, and teachers reported regarding children's behavior problems. We assessed both mothers' overall general use of the discipline strategies, and their use of the same strategies following transgressions in the academic domain, an area which the two groups emphasize to differing degrees. Consistent with hypothesis, controlling discipline in academic situations had more positive consequences in the FSU group compared with the Israeli‐origin group. In contrast, and as predicted, cultural group was not a moderator of mothers' overall, general use of the same discipline strategies. The findings illustrate how taking the situation into account can inform examination of the moderating role of cultural group.     

Using Technology to Facilitate Collaboration in Community-Based Participatory Research (CBPR)

This study explores the use of Computer-Supported Collaborative Work (CSCW) technologies, by way of a computer-based system called iCohere. This system was used to facilitate collaboration conducting Community-Based Participatory Research (CBPR). Data was gathered from 13 members of a Community Collaborative Board (CCB). Analysis revealed that iCohere served the following functions: facilitating communication, providing a depository for information and resource sharing, and allowing for remote meeting attendance. Results indicated that while iCohere was useful in performing these functions, less expensive technologies had the potential to achieve similar goals if properly implemented. Implications for future research on CSCW systems and CBPR are discussed.     

Problem‐ and solution‐focused characteristics of parenting support, 3 years after implementation of the solution‐focused approach: A qualitative content analysis

In recent years, solution‐focused parenting support has been developed and implemented as a promising brief and strength‐based approach. Given the fundamental differences between solution‐focused and the historically more common problem‐focused parenting support and the complexity of transforming professional practice, an actual shift towards solution‐focused parenting support can be expected to be limited up to now. However, because research into the specific communication characteristics of professional parenting support is currently lacking, no conclusion can be drawn at present. Therefore, this study aims to explore the current problem‐ and solution‐focused characteristics of parenting support in the Dutch youth healthcare (YH). In total, 15 support sessions performed by 10 public health nurses were audio recorded and transcribed verbatim. A detailed qualitative content analysis of professional communication was conducted to identify problem‐ and solution‐focused factual, expressive, relational and appealing aspects of parenting support. Problem‐focused characteristics dominated all sessions of parenting support. This study is the first to thoroughly analyse the problem‐focused and solution‐focused communication characteristics of professional parenting support using a qualitative content analysis. Parenting support practice in the Dutch YH did not shift substantially to a solution‐focused approach. More effort is required to stimulate and facilitate this professional transformation.     

Assessing Risk‐Based Upper Limits of Melamine Migration from Food Containers

Melamine contamination of food has become a major food safety issue because of incidents of infant disease caused by exposure to this chemical. This study was aimed at establishing a safety limit in Taiwan for the degree of melamine migration from food containers. Health risk assessment was performed for three exposure groups (preschool children, individuals who dine out, and elderly residents of nursing homes). Selected values of tolerable daily intake (TDI) for melamine were used to calculate the reference migration concentration limit (RMCL) or reference specific migration limit (RSML) for melamine food containers. The only existing values of these limits for international standards today are 1.2 mg/L (0.2 mg/dm²) in China and 30 mg/L (5 mg/dm²) in the European Union. The factors used in the calculations included the specific surface area of food containers, daily food consumption rate, body weight, TDI, and the percentile of the population protected at a given migration concentration limit (MCL). The results indicate that children are indeed at higher risk of melamine exposure at toxic levels than are other groups and that the 95th percentile of MCL (specific surface area = 5) for children aged 1–6 years should be the RMCL (0.07 mg/dm²) for protecting the sensitive and general population.