Don't just do something, stand there: responding to unrelieved patient suffering

Nurses are taught a variety of interventions to relieve patient suffering. They are often more comfortable with patient suffering that is physical in nature rather than psychological, existential, and spiritual. Remaining present for patients and families whose suffering cannot be easily relieved is particularly challenging. This article describes how an expert nurse responded to unrelieved suffering and offers insight into ways of being present for patients and families.     

Risk and protective factors for depression and substance use in an adolescent child welfare sample

Research on the mental health needs of maltreated youth in out-of-home care remains limited. The goal of the current study was to examine two common mental health concerns (i.e., depression, substance use) among 122 12-15 year olds in out-of-home placements. Specifically, we investigated potential risk and protective factors among socio-demographic, maltreatment, youth, family, and community variables. We relied on data collected through the AAR-C2, a Canadian needs assessment and outcome monitoring tool. Approximately 4 in 10 (39.2%) youth endorsed at least one mental health problem, which we defined as the youth scoring at least one standard deviation above the sample mean for the depression items and the youth indicating the presence of alcohol and/or substance use over the past year. Almost 1 in 10 (8.3%) reported struggling with both mental health issues. Results from logistic regressions indicated that adolescent females were at higher risk of experiencing depression than males, and increasing age was associated with increased risk for substance use. Turning to protective factors, results indicated that the greater the perceived quality of the youth-caregiver relationship, the lower the risk for mental health difficulties (i.e., depression, substance use). Moreover, participation in extracurricular activities appeared to protect youth against depression or substance use. Results imply that the youth-caregiver relationship and involvement in extracurricular activities are important areas to consider to promote the well-being of maltreated youth in out-of-home care.     

Autocorrelation in real-time continuous monitoring of microenvironments

Interpretation of continuous measurements in microenvironmental studies and exposure assessments can be complicated by autocorrelation, the implications of which are often not fully addressed. We discuss some statistical issues that arose in the analysis of microenvironmental particulate matter concentration data collected in 1998 by the Harvard School of Public Health. We present a simulation study that suggests that Generalized Estimating Equations, a technique often used to adjust for autocorrelation, may produce inflated Type I errors when applied to microenvironmental studies of small or moderate sample size, and that Linear Mixed Effects models may be more appropriate in small-sample settings. Environmental scientists often appeal to longer averaging times to reduce autocorrelation. We explore the functional relationship between averaging time, autocorrelation, and standard errors of both mean and variance, showing that longer averaging times impair statistical inferences about main effects. We conclude that, given widely available techniques that adjust for autocorrelation, longer averaging times may be inappropriate in microenvironmental studies.     

Modeling Fetal Death and Malformation in Developmental Toxicity Studies

We review approaches to dose-response modeling and risk assessment for binary data from developmental toxicity studies. In particular, we focus on jointly modeling fetal death and malformation and use a continuation ratio formulation of the multinomial distribution to provide a model for risk. Generalized estimating equations are used to account for clustering of animals within litters. The fitted model is then used to calculate doses corresponding to a specified level of excess risk. Two methods of arriving at a lower confidence limit or Benchmark dose are illustrated and compared. We also discuss models based on single binary end points and compare our approach to a binary analysis of whether or not the animal was 'affected' (either dead or malformed). The models are illustrated using data from four developmental toxicity studies in EG, DEHP, TGDM, and DYME conducted through the National Toxicology Program.     

New Voices,Old Beliefs: Forest Environmentalism Among New and Long-Standing Rural Residents1

Abstract In the on-going sociological debate over rural-urban differences, rural conflict over natural resources is often attributed to environmental attitudes of new residents from urban areas. An alternative hypothesis is that new residents provide not new attitudes, but a new voice for attitudes already held by many local residents. Data from a survey of residents of communities near two national forests show little support for the hypothesis that residential status affects forest management attitudes, dissatisfaction, or action. The findings support the “new-voice” thesis and show that it is often a female voice.     

Behavioral management of command hallucinations to harm in schizophrenia

The study objective was to evaluate changes in prevalence of command hallucinations to harm self or others, characteristics and intensity of auditory hallucinations, and levels of anxiety and depression after attendance at a 10-session course teaching behavioral strategies for managing persistent auditory hallucinations to adult outpatients with schizophrenia. Prevalence of command hallucinations to harm self or others was measured at baseline, end of course, and 1-year post-course. Pre-course scores on the Characteristics of Auditory Hallucinations Questionnaire, Unpleasant Voices Scale, tension-anxiety subscale of Profile of Mood States, and Beck Depression Inventory-II were compared with scores immediately post-course and 1 year later. The prevalence rate of command hallucinations to harm self of 44% at baseline decreased to 24% immediately after attending the 10-session course and remained at 24% 1-year post-course. The prevalence rate for command hallucinations to harm others of 21% at baseline decreased to 16% at end of course and 17% 1-year post-course. People who attended the course perceived it as helpful, and improvement was seen in all seven characteristics of auditory hallucinations, intensity of auditory hallucinations, and anxiety and depression immediately after the course and 1-year post-course.     

Assisted living facility administrator and direct care staff views of resident mental health concerns and staff training needs

This community needs assessment surveyed 21 administrators and 75 direct care staff at 9 larger and 12 smaller assisted living facilities (ALFs) regarding perceptions of resident mental health concerns, direct care staff capacity to work with residents with mental illness, and direct care staff training needs. Group differences in these perceptions were also examined. Both administrators and directcare staff indicated that direct care staff would benefit from mental health-related training, and direct care staff perceived themselves as being more comfortable working with residents with mental illness than administrators perceived them to be. Implications for gerontological social work are discussed.     

“Once in a Blue Moon … Anything is Possible”

Each of the articles in this volume highlights concerns and issues related to cultural diversity and community development. Together they provide significant guidance for further work in theory construction and curriculum development, and offer direction for effective practice and research. Leadership development, self-help, and empowerment practice approaches are presented for work in communities of color and neo-gemeinschaft communities. Effective methods and strategies for working with diverse populations in changing social and economic times are provided for community practitioners and faculty.