Stages of family therapy: A developmental model

While it is not possible to assert that all family treatment follows a universal and sequential pattern, commonalities can be ascertained which can help the therapist maintain objectivity and provide direction for himself and the family. Four major stages are outlined, each with several substages: 1) the preparation stage—mutual acceptance, definition of the problem, formulation of goals; 2) the transition stage—beginning actualization, crisis, reformulation and acceptance; 3) the consolidation stage—investment in the therapeutic work, working through alternatives; 4) the terminal stage—introduction to termination, defining the duration and format of the ending. Universal issues are identified, tasks for the therapist are outlined and common problems are described.     

STRATEGIC FACILITY PLANNING: THE ANALYSIS OF OPTIONS

This paper addresses the issue of uncertainty in planning the long-term development of facility systems. In certain instances, the high variance of a single future forecast can be reduced by using a set of alternative future scenarios. By carefully selecting facility configurations, the planner can delay the selection of a future set of facility sites at little or no sacrifice while additional information is gathered and uncertainty reduced. This allows the planner to maintain flexibility in adapting to a complex and dynamic environment. Several models are presented for different planning contexts. Examples for each, as well as a robust bicriterion solution heuristic, are also provided.     

Object Permanence in Five‐and‐a‐Half‐Month‐Old Infants?

Event Set × Event Set designs were used to study the rotating screen paradigm introduced by Baillargeon, Spelke, and Wasserman (1985). In Experiment 1, 36 5 1/2‐month‐old infants were habituated to a screen rotating 180° with no block, a screen rotating 120° up to a block, or a screen rotating 180° up to and seemingly through a block. All infants were then tested on the same 3 events and also a screen rotating 120° with no block. The results indicate that infants are using novelty and familiarity preference to determine their looking times. To confirm this, in Experiment 2, 52 5 1/2‐month‐old infants were familiarized on either 3 or 7 trials to a screen rotating 180° with no block or a screen rotating 120° with no block. All infants were then tested on the same test events as in Experiment 1. Infants with fewer familiarization trials were more likely to prefer the familiar rotation event. The results of these 2 experiments indicate that infants did not use the possibility or impossibility of events but instead used familiarity or novelty relations between the habituation events and the test events to determine their looking times, and suggest that the Baillargeon et al. study should not be interpreted as indicating object permanence or solidity knowledge in young infants.     

The Use of Tracking Technologies for the Analysis of Outdoor Mobility in the Face of Dementia: First Steps into a Project and Some Illustrative Findings From Germany

As people age in place, cognitive impairment is a major threat to maintaining out-of-home mobility. The SenTra project measures outdoor mobility by taking advantage of tracking technology in an interdisciplinary project involving researchers from geography, social work, gerontology, psychology, and medicine disciplines. The project assesses mobility patterns of urban-dwelling demented and mildly cognitively impaired elders and cognitively intact persons over a period of 3 years in Israel and Germany. The main objectives are to learn more about out-of-home mobility by means of global positioning system/geographical information system technology, to analyze the relationships between cognitive functioning, mobility behavior, and well-being, to examine the ethical implications of the use of advanced tracking technologies in this population, and to assess the potential of tracking technologies in the diagnosis of various types of cognitive impairment. The article presents preliminary findings to illustrate the potential of interdisciplinary data analyses to be performed later in the project. Pilot data were drawn from a combined psychiatric, psycho-social, and tracking data assessment of a group of 19 men and women between 63 and 80 years of age (7 who were healthy, 6 who were mildly cognitive impaired, 6 who were demented) living in Germany. The findings revealed that healthy participants have better health and higher levels of well-being and smaller networks compared to elders who are cognitively impaired. Examples of daily outdoor trips indicate meaningful mobility patterns and the need to combine psycho-social and geographical data to understand the relationships between outdoor mobility, socio-structural dimensions, behavior patterns, and well-being. By achieving its aims, the project will be able to make a substantial contribution to basic, applied, and clinical knowledge gaps in the area of mobility and cognitive impairment research.     

Postcoital Contraception: Student Choices and Effectiveness

Abstract

A five-semester study was undertaken to obtain information about the selections patients make when given a choice of postcoital contraceptives and the effectiveness of those choices. Three postcoital contraceptive (PCC) regimens were used: a copper intrauterine device (IUD), high-dose estrogen (HDE), and an estrogen/progestin combination (E/P). Four hundred eighty-two patients requested PCC. Two percent selected an IUD, 9% HDE, and 89% chose E/P. There were 8 pregnancies–7 in the E/P group and 1 in the HDE group. It is concluded that PCC is an effective second chance to prevent unintended pregnancy. When given a choice, most patients will select E/P. During this same time span, 931 other students requested pregnancy tests. Forty-four percent (416) of those tests were positive, and 62% (254) of those with positive tests had a voluntary interruption of pregnancy (VIP).

“Yogurt–An Autodigesting Source of Lactose,” JOSEPH C. KOLARS, MICHAEL D. LEVITT, MOSTAFA AOUJI, DENNIS A. SAVAIANO. Large quantities of yogurt are consumed by some lactase-deficient population groups. We used breath hydrogen measurements to determine whether lactase-deficient subjects absorbed lactose in yogurt better than lactose in milk. Ingestion of 18 g of lactose in yogurt resulted in only about one third as much hydrogen excretion as a similar load of lactose in milk or water, indicating a much better absorption of lactose in yogurt. Ingestion of yogurt also resulted in fewer reports of diarrhea or flatulence than did a similar quantity of lactose ingested in milk or a water solution. The enhanced absorption of lactose in yogurt appeared to result from the yogurt organisms. This autodigesting feature makes yogurt a well-tolerated source of milk for lactase-deficient persons and may explain the widespread consumption of yogurt by lactase-deficient population groups. (New England Journal of Medicine 1984;310:1–3)     

Postcoital Contraception: Awareness of the Existence of Postcoital Contraception among Students who have had a Therapeutic Abortion

Abstract

A two-semester survey was conducted to obtain information about the underutilization of postcoital contraception (PCC) in terms of fear about using it or ignorance of its existence. Among 437 students attending the women's health clinic at California State University/Fresno, 41% had had a therapeutic abortion. One hundred fifty-two, or 84.9%, of those who had had terminations were not aware of PCC. Some were not aware that they had taken a chance of becoming pregnant. It is concluded that students who have had a therapeutic abortion either were unaware of the existence of PCC or were unaware they were risking pregnancy and therefore unable to utilize PCC to avoid the need for a surgical procedure. It would appear that ignorance about the existence of PCC is a major reason for its underutilization.

“Treatment of First Episodes of Genital Herpes Simples Virus Infection with Oral Acyclovir,” YVONNE J. BRYSON, MARYANNE DILLON, MICHAEL LOVETT, GUILLERMO ACUNA, STEPHEN TAYLOR, JAMES D. CHERRY, B. LAMAR JOHNSON, EDWARD WIESMEIER, WILLIAM GROWDON, TERRI CREAGH-KIRK, RONALD KENNEY. We performed a double-blind placebo-controlled trial of oral acyclovir in the treatment of first episodes of genital herpes simplex virus infections in 48 young adults (31 women and 17 men). Subjects were randomized to receive either placebo or acyclovir (200 mg per dose) five times daily for 10 days; they were examined on at least eight visits until healed and at monthly visits thereafter. Acyclovir treatment, as compared with placebo, significantly reduced virus shedding, new lesion formation after 48 hours, and the duration of genital lesions in both men and women. The total duration and severity of clinical symptoms (such as pain, adenopathy, dysuria, and malaise) were significantly reduced by acyclovir in both men and women by the third and fourth day, respectively (P ≤ 0.025), as compared with placebo. No toxicity was observed. Recurrence rates have so far been similar in placebo and acyclovir recipients. Oral acyclovir treatment of first-episode genital herpes simplex virus infections is clincially effective, but it does not seem to prevent virus latency or associated recurrent disease. (New England Journal of Medicine 1983;308:916–21)

“Cesarean Section: Risk and Benefits for Mother and Fetus,” BEN P. SACHS, BRIAN J. McCARTHY, GEORGE RUBIN, ANTHONY BURTON, JULES TERRY, CARL W. TYLER. We studied the effects of cesarean section on neonatal mortality for breech infants and low-birth weight vertex infants using data from the Georgia neonatal surveillance network on 392,241 singleton deliveries between 1974 and 1978. The risk of neonatal death for breech infants weighing 4,000 g or less delivered vaginally was significantly higher than the risk for those delivered by cesarean section. The lower the birthweight, the higher the risk for a vaginal breech delivery. For breech infants weighing 1,000 to 2,500 g, the risk was almost 2½ times greater for a vaginal delivery v a cesarean delivery. The best outcome for high-risk vertex infants weighing 1,000 to 1,500 g was for those delivered by cesarean section in a tertiary perinatal center. An increase in the cesarean section rate may be associated with increased neonatal survival; however, the benefits must be weighed against the costs of an increased maternal mortality and morbidity. (Journal of the American Medical Association 1983;250:2157–2159)     

The role of acceptance sampling in modern quality control

Acceptance sampling procedures can be employedina program of accept ance control to achievebetterqualityat lowercost. An overview of the application of moder nacceptance samplingplans, schemes, andsys tems is described with emphas is on the iruse in facilitating process control. Sampling procedures must continually bemade to matchexist in gconditions, and to self-destruct whennolonger warranted. In this way they can be usedinane voluti on ary manne rina continuing program of acceptance control for quality improvement. Implemen- tation of process control canbefacilitated by on-going application of acceptance control to achieve the full be nefits of statistical quality control.