bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical Problem Solving
Authors: Elstein Arthur S. , Shulman Lee S. , Sprafka Sarah A.
Published: March 2007

This essay reviews the origins, findings and influence of the monograph Medical Problem Solving: An Analysis of Clinical Reasoning. Majorfindings of the monograph are reviewed in the light of subsequent work and the results of selected studies of clinical cognition are related to the book's conclusions, thus sketching the growth of this field of research in the decade since publication. Several remaining methodologicalproblems and scholarly issues in the field are discussed, including: sampling cases and subjects, the definition of medical expertise, the role of verbal report in analyzing thinking, the level of clinical realism needed in research, and the relation of informationprocessing approaches to more quantitative approaches such as behavioral decision theory and social judgment theory.
The Conduct and Neglect of Self-Studies in Medical Education
Authors: McArtor Robert E. , Kliot Lily A.
Published: March 2007

All Liaison Committee on Medical Education (LCME) accredited medical schools were surveyed to evaluate 12 aspects of selfstudies employed in medical education; we obtained a 71% response rate. The survey instrument offered responses from a list of alternatives, ratings on Likert-like scales, and openended comments. The majority of schools are engaged in self-study to meet accreditation needs or administrative mandate. Fewer than half of the respondents had performed evaluation of departments or courses during the two years preceding this survey. Few respondents identified a model or process of evaluation practice that guides their work, and there was little evidence that they have taken advantage of recent developments in evaluation theory and practice. Externally developed methodology and external expert review were used much less frequently than internally developed instruments or LCME guidelines. Only half of the respondents reported that results of self-studies were discussed with the school leadership. Schools of medicine may benefit by redirecting resources committed to institutional self-study to developing more appropriate evaluation practices for medical education.
Enhancement of Validity Through Qualitative Approaches
Authors: Carey Martha Ann , Smith Mickey W.
Published: March 2007

Validity of research in a medical environment is enhanced through incorporating the patient's perspective by using qualitative approaches. Our efforts to improve the validity of measures led us to examine the research process more broadly through mechanisms ofpatientparticipation: a protocol adviser, a participantadvisory panel, and focus groups. In our research program of biopsychosocial HIVstudies in the military population, feedback from patient participants provided the research staff with information important for refining standard measures, improving the research process, and interpreting the quantitative data analyses.
The Assessment of Professional Competence
Authors: Kane Michael T.
Published: March 2007

Valid assessment of professional competence has proven to be an elusive goal. Objective tests, direct observation ofperformance, overall ratings of competence, and simulations have been tried and found wanting in one way or another. Objective test items are criticized as being unrealistic and therefore invalid. Direct observation tends to be very unreliable and therefore invalid. Simulations and overall ratings of competence share both of these flaws to some extent. Basically, you can't win. This article outlines some of the many ways to lose and some ways to cut these losses. In doing so, it proposes a general framework for evaluating the validity of measures of competence, and it uses this framework to examine the strengths and weaknesses of three approaches to the assessment ofprofessional competence: direct observation, simulation, and objective testing.
Health Decision Makers' Perceptions of Program Evaluation
Authors: Carpinello Sharon E. , Newman Dianna L. , Jatulis Linnea L.
Published: March 2007

This study investigates alternate reasons for conducting program evaluation in community health care settings and their relationships with information needs. One hundred thirtysix community health care decision makers were used in this survey. Results of a factor analysis indicated three major purposes for conducting program evaluation, listed in order of use: accreditation, true evaluation, and pseudoevaluation. A second analysis on need for information showed little differences in responses. Five factors were identified: descriptive information for validity/credibility, opinions, financial information, action information, and empirical information for validity! credibility. There was no relationship between thefive types of information needs and accreditation, suggesting that accreditation was a symbolic use of evaluation; however, information needs were predictors of true evaluation and pseudolquasi evaluation. Regression analyses indicated that descriptive information providing evidence of validity/credibility was predictive of the purpose of true evaluation whereas empirical and descriptive evidence of validity/credibility were predictors of quasi/pseudo evaluation. Information for decision makers acted as a suppressor variable on the latter.
Prevalence of Chronic Fatigue Syndrome-Related Symptoms among Nurses
Authors: Jason Leonard A. , Taylor Stephanie L. , Johnson Sharon , Goldston Stephen E. , Salina Doreen , Bishop Peter , Wagner Lynne
Published: March 2007

Chronic Fatigue Syndrome is an illness that is characterized by debilitating fatigue and a group of other related symptoms. Few epidemiological studies have been conducte4 and none have focused on a nursing population. The present study is the first to assess the prevalence of Chronic Fatigue Syndromerelated symptoms in a sample of nurses. Demographic characteristics, symptoms, and possible prevalence rates are presented and discussed When using both narrow and more inclusive criteria to define this symptom complexr higher rates of this disorder were found than in previous epidemiological studies. The implications of thesefindings are discussed
Course Content Coverage as a Measure of Instructional Quality
Authors: Dolmans Diana H.J.M. , Guselaers Wim H. , Scemidt Henk G.
Published: March 2007

In order to measure instructional quality, several methods have been proposed in the literature, among them student performance on achievement tests and student ratings of the quality of instruction. Both methods have in common that they tend to ignore course content coverage, although this is an important determinant of instructional quality. In this article a procedure is described which is used to assess students' actual learning activities. This procedure, the Topic Checklist, makes use of student ratings. Reliability, validity, and utility studies were conducted. The results suggest that the Topic Checklist is a reliable and fairly valid procedure to evaluate course content coverage and to detect problem areas in a course, providing feedback useful for carrying out improvements.
Using a New Program Evaluation Model to Chart the Outcomes of an Educational Intervention in Residency Training
Authors: Blumberg Phyllis , Deveau Eleanor J.
Published: March 2007

The purpose of this article is to introduce a new outcome-oriented, utilization-focused, and practical approach to program evaluation: Charting the Outcomes of Educational and Clinical Approaches (COECA) model. It provides a framework that encourages stakeholders to consider academic dissemination, product development, and implementation as three primary outcomes when evaluating educational and clinical approaches. The model then identifies measurements of the impact of each of these primary outcomes. Finally, it outlines three secondary outcomes that focus on education, clinical service, and administration. As an example, this article discusses the application of the model to an educational intervention in residency training. This intervention has been implemented at two sites. Secondary outcomes include increased competency of residents and a change in responsibilities among health care team members. The COECA modelprovides an easy-to-apply and efficient method for documenting actual progress and determining potentialforfurther development.
Introduction
Authors: Bausell R. Barker
Published: March 2007

I am pleased to announce thatthis and the next issue of Evaluation & the Health Professions are devoted to what may be the most important methodological innovation developed during the last half of this century. I would like to dedicate these issues to Gene V Glass, who galvanized the research community with (a) his 1976 article entitled "Primary, Secondary, and Meta-Analysis of Research, " (b) the publication of two extremely influential metaanalyses (Glass & Smith, 1979; Smith & Glass, 1977) demonstrating definitive effects for two of the most important (and controversial) variables in the fields of psychology and education (i.e., psychotherapy and class size, respectively), and (c) his seminal text in the area published by Sage (Glass, McGaw, & Smith, 1981)-all of which occurred in a span of less than 5 years. No one can predict the future, but Ifirmly believe that Gene V Glass will be awarded a prominent place in the history of science for introducing andfostering the growth of this very powerful means of synthesizing knowledge.
Evaluation Issues and Strategies for Community-Based Organizations Developing Women's HIV Prevention Programs
Authors: O'Connell Ann Aileen , Bol Linda , Langley Sandra C.
Published: March 2007

This article discusses issues and strategiesfor program evaluation particularly useful for community-based organizations (CBOs) involved in the development and implementation of HIV prevention programs for women. The approach the authors present is an extension of a traditional public health paradigm suggested for use in the development and evaluation of violence prevention programs. This study incorporates Becker's Health Belief Model, which provides a framework for viewing the influence of various psychosocial variables on healthrelated behavior, into this development and evaluation paradigm. Factors influencing the successful development and evaluation of HIV prevention programs for women are reviewed and discussed. The purpose of this article is to provide some guidance to CBOs to strengthen their evaluation strategies and to encourage their use of evaluation during all phases of program development and implementation.
The Impact of a Physician Intervention Program on Older Women's Mammography Use
Authors: Preston Jeanetie A. , Grady Jacqueline N. , Schulz Allyson F. , Petrillo Marcia K. , Scinto Jeanne D.
Published: March 2007

The Mammography Optimum Referral Effort (MORE) is a physician office-based intervention program initiated by the Connecticut PeerReview Organization (CPRO)to increase mammography use among older women in Connecticut. Three locales in the state were targetedfor the MORE intervention based on identified low mammography rates in women aged 65 years and older Thirty-seven physicians participated from March 1, 1996, to August 31, 1996. Annual mammography rates were derived by merging Medicare Part B mammography claims with a database from the Connecticut TumorRegistry. This strategy allowed us to exclude women with a prior history of breast cancer from the analysis, in order to estimate screening rates. The MORE intervention was associated with an absolute increase of 5.9%6, which represents a relative increase of 15.4%, in annual mammography use. Ourfindings suggest that a multifaceted physician intervention is capable of increasing mammography use among older women.
In pursuit of the ineffable: how television found the eclipse but lost the plot
Authors: Marriott Stephanie
Published: March 2007

Conventionally, live television constructs the event by bringing together many spatially dispersed occurrences and articulating them through the electronic mediation of the broadcast. This article discusses one live event - the total solar eclipse in August 1999 - for which this `complex connectivity' at the heart of the event was to prove deeply problematic. In the case of the eclipse, what was at stake was not a set of different but related occurrences but rather the same occurrence - the singular and liminal moment of totality - as it occurred and re-occurred in different places. Caught up in a set of contradictory imperatives - to produce the moment, to deliver to the viewer a sense of `being there' but also to deliver the everywhere of the occasion - television mislaid the event.
Journalism's `discursive events' and sociopolitical change in Sweden 1925-87
Authors: Ekecrantz Jan
Published: March 2007

This article reports on a study which tries to define types of discursive event produced by the journalistic institution and relate these events to three different sociopolitical and historical situations in Sweden. As well as a strong substantive and historical argument, there is also a methodological argument about the way in which discursive practices have to be analysed at both micro (for example, grammar and word frequency) and macro (for example, text constructions, modes of address) levels in order to be correlated with discursive formations and shifts in the social order. Linguistic, content and sociostructural aspects are brought together to produce three complex time-tableaux, each of which is given synchronic as well as diachronic attention.
Answering back: the telephone, modernity and everyday life
Authors: Betteridge Jenie
Published: March 2007

This article, based on ethnographic research on a small island off the coast of South West Ireland, studies the role of the telephone in changing the social relationships on the island. It compares the impact of the telephone with that of television. Television was seen by the islanders as ahistorical. It was seen as the new and as impacting decisively on their way of life. The telephone, on the other hand, was seen as a continuation of older forms of communication. The article traces the implications of the shift from a communal telephone to private domestic telephony and contrasts the islanders' adaption with that of the Amish. It argues that telephony has facilitated interaction with modernity and that the question is not whether modernity has eroded community but, rather, in what form has community been preserved. Its conclusion is positive, that the impact of telephony, both on its own and in combination with broadcasting, has been progressive and liberating, the old patterns of communication behaviour being replaced with the relaxed, democratized practices of public discourse.
The Normative Anticipation of Retirement by Older Workers
Authors: Ekerdt David J. , Kosloski Karl , Deviney Stanley
Published: March 2007

The scope of explanation for retirement behavior could be greatly enlarged by acknowledging workers’ extended engagement with the question before the event—its “givenness” in their future, and their course of action toward it. This study provides evidence for such extended involvement among workers aged 51 to 61 in the 1992 Health and Retirement Study (HRS) who saw themselves being within 15 years of retiring. To the extent that workers foresaw less time left at work, they reported more frequent thinking and talking about retirement. This pattern was quite general. The consideration given to retirement was, as expected, more frequent in circumstances that might orient workers toward the future. However, even absent these circumstances, subjective proximity still predicted the topicality of retirement. Widely held, albeit individual, timetables for retirement demonstrate its embeddedness in the subjective life course of older workers.
The Effects of an Acute Stressor on Depressive Symptoms among Older Adults
Authors: Tyler Kimberly A. , Hoyt Dan R.
Published: March 2007

This study uses longitudinal data to examine the potential moderating effects of social support and age among older adults exposed to an acute stressor. Using a sample of 651 older persons, data were gathered in the spring of 1992 and in the fall of 1993, approximately 60 days after the peak impact of flooding in the Midwest. Results indicate a positive association between pre- and postflood depression and a negative association between social support and postflood depression. For the youngest of the two older age groups, there is also a positive association between flood exposure and post-flood depression, controlling for prior levels of depression. Age interactions reveal that social support moderates the effects of flood exposure on depression only for the younger age group.
Living Arrangements, Income Pooling, and the Life Course in Urban Chinese Families
Authors: Treas Judith , Chen Jieming
Published: March 2007

Survey data from Baoding, China, show that the child’s life-course location affects the likelihood of residing with a parent. When parents and grown children co-reside, the child’s progress toward full adulthood increases the likelihood that the generations will budget separately. Marriage is the most significant marker of adulthood, but its effects differ for sons and daughters.
Differences between Older Volunteers and Nonvolunteers
Authors: Warburton Jeni , Terry Deborah J. , Rosenman Linda S. , Shapiro Margaret
Published: March 2007

It has been suggested that older people are a rich potential source of volunteers, as prior literature has highlighted the benefits and rewards of volunteering in later life. This article examines differences between volunteers and nonvolunteers in a random sample of older people resident in Brisbane, Australia. Using the theory of planned behavior as a framework, the article focuses on the beliefs that distinguish those who volunteer from those who do not. Findings from the study allowed for an assessment of both the costs and benefits associated with volunteering; beliefs about the support of others, including the broader community, to volunteer; and beliefs about the barriers that might prevent volunteering. The implications of these findings to a country with an aging population are discussed.
Person-Environment Congruence and Sociability
Authors: Carp Frances M. , Carp Abraham
Published: March 2007

The move from an isolating living environment to one rich in social opportunity had long-term (eight-year) effects of increased sociability and improved satisfaction among the majority of elderly in-movers who had chosen and been screened as suitable for the actively sociable situation, compared to similar persons who did not make the move. Individual differences among movers were important also: Persons most active socially and those rated high in extraversion, prior to the move, tended to make the greatest gains in social behavior and satisfaction. For a minority, effects were small or even reversed. The findings support the importance of congruence between the person's sociability needs and the environment's sociability resources.
Social Networks and Help-Seeking among the Elderly
Authors: Rundall Thomas G. , Evashwick Connie
Published: March 2007

Although it is widely believed that social networks play a role in determining help-seeking behavior, empirical studies have reported inconsistent findings. It is argued here that social network tends to be inappropriately equated with support network. This is partly because virtually all of the varied conceptualizations of social networks ignore the perceived satisfaction of the focal individual with his/her interaction with the network. We develop a typology of relationships with social networks which includes information about both the level of one's interaction with the network and one's satisfaction with the level of interaction. The resulting typology has four categories: engaged, abandoned, trapped, and disengaged. Empirical analysis of data on 883 elderly persons reveals that the categories are differentially related to use of health and social services among the elderly. The implications of these findings for aging policy are discussed.
Social Contacts, Social Instrumentality, and Adjustment of Institutionalized Aged
Authors: Parmelee Patricia A.
Published: March 2007

A correlational study examined social instrumentality of institutionalized aged in terms of self- versus other-initiated contacts with family, community-dwelling friends, and coresidents. Correlations with life satisfaction, self-esteem, and perceived social control indicate positive associations with self- but not with other-initiated contacts with friends and fellow nursing home residents. Although family contacts were generally unrelated to adjustment, positive correlations did emerge for self-initiation of long-distance interactions with family members. Results are discussed in terms of parallels with previous experimental research on social control for institutionalized elderly and of differential functions of family and friendship interactions for this population.
Pet Possession and Well-Being in Elderly Women
Authors: Ory Marcia G. , Goldberg Evelyn L.
Published: March 2007

The purpose of this article is to identify factors related to subjective well-being in the elderly. Structured interviews were conducted with 1073 white married women aged 65-75 living in Maryland in order to examine the role of pet ownership as an independent predictor of perceived happiness in elderly women. Controlling for sociodemographic, health status, and social interaction factors, the simple presence of pets in the households was not related to happiness. However, further multivariate analyses revealed that the relationship between pet ownership and happiness was complex, dependent upon the nature of the animal-human interaction as well as the social context in which the women lived. Preliminary findings indicate: (1) a larger percentage of women who are not very attached to their pets are unhappy, compared to women who are very attached to their pets or even those with no pets at all; and (2) the relationship between pet ownership and happiness is dependent on socioeconomic background, with pet ownership being associated with greater happiness among those of high SES but with less happiness among those of lower SES. The importance of specifying the conditions under which pet ownership is related to psychological well-being is emphasized.
Socialization to the Chronic Sick Role in Later Life
Authors: Nuttbrock Larry
Published: March 2007

This study examines sick role identification and sick role retention as interrelated aspects of socialization to a chronic sick role. Focusing on physically impaired older people (55-85) and adopting an interactionist view, sick role socialization is seen in terms of both conformity (mirroring the role casting of others) and improvisation (portraying sickness in pursuit of social support, legitimated dependency, and relief from social strain). Both models are generally supported by the data.
Older Women Living Alone
Authors: Carp Frances M. , Christensen David L.
Published: March 2007

Relationships of subjective residential satisfaction to psychological well-being have been demonstrated, but it has proved difficult to document relationships between objective environmental variables and well-being. In this study, environmental variables were selected on the basis of a theoretical model for relevance to human needs and were measured with technical assessment items scaled for internal consistency. Outcomes were two factors derived from a battery of instruments in the domain of psychological well-being. Direct effects of objective environmental measures on psychological well-being were observed as well as indirect effects through subjective satisfaction with home and neighborhood.
Occupation, Impaired Health, and the Functional Capacity of Men to Continue Working
Authors: Chirikos Thomas N. , Nestel Gilbert
Published: March 2007

Whether the functional capacity of older men to remain at work differs by occupational assignment is an important consideration in judging policies designed to advance the age of retirement. A continuous-time Markov model of retirement, disability, and death is used to test hypotheses about the influence of physically demanding work and impaired health on the ability to delay retirement. The model is estimated with panel data on a nationally representative sample of older American males. Physical job requirements and health conditions are found to affect the likelihood of retiring in a disabled state. However, cohort projections of the fractions of workers in physically demanding and sedentary job categories retiring nondisabled are very similar. Special policy consideration of workers in physically demanding occupations may therefore be questioned.
Household Composition among the Nonmarried Elderly
Authors: Mutchler Jan E.
Published: March 2007

Differences in household composition between Black and White women have often been explained as resulting from differences in the resources of the two groups, particularly economic differences. A competing viewpoint holds that living arrangements reflect the cultural context within which life choices are negotiated. The purpose of this article is to assess the relative merits of these arguments. In this analysis, the extensive data available in the 1984 panel of the Survey of Income and Program Participation are employed. Indicators of health, kinship, income, and wealth are included in the analysis of living arrangements among Black and White women aged 55 and over. The results indicate that these resources are associated with choice of living arrangements among members of the two groups, but that Black and White women respond differently to levels of wealth and health when making decisions about household composition.
The Composition of Multigenerational Households that Include Elders
Authors: Coward Raymond T. , Cutler Stephen J.
Published: March 2007

Using a new procedure to recode data from the 1980 U.S. census, the relationships within multigenerational households are examined from the perspective of the elder. Differences in the household composition of two-generation and three-or-more generation households by age are examined. Among older respondents, fewer elders lived with spouses, parents or parents-in-law, or siblings or siblings-in-law. In contrast, as age increased, a higher percentage of elders lived with children, grand children, or other kin. The pattern of coresidence with adult children varied by type of household. In two-generation households, more elders lived with sons than with daughters; in three-or-more generation households, a higher proportion of elders lived with daughters than with sons. Across relationships with the previous generation (parents), the collateral generation (siblings), and subsequent generations (children), more elders resided with blood relatives than with in-laws.
Status Attainment Revisited
Authors: Kamo Yoshinori , Ries Lynn M. , Farmer Yvette M. , Nickinovich David G. , Borgatfa Edgar F.
Published: March 2007

Using data from the National Survey of Families and Households, this article examines factors affecting one's education, occupational prestige, and family income. The size of the data set (N = 9,643) permits us to analyze various factors pertaining to the status attainment according to the particular age group of the respondent. Because the analyses include female respondents, care was taken to incorporate the status attainment of the family along with that of the individual. The results largely support the past research in the area. Some notable findings include that (a) the effects of human capitals on education seem to be on the decline, if not uniformly, particularly regarding race and place of residence; (b) occupational prestiges are strongly affected by factors other than the respondent's own education; and (c) income is relatively unpredictable even when the respondent's marital status, education, and occupational prestiges are included as predictors.
Systems of Parent Care within Sibling Networks
Authors: Stoller Eleanor Palo , Forster Lorna Earl , Duniho Tamara Sutin
Published: March 2007

This article examines factors related to the participation of adult children in their elderly parents' helping networks. A three-stage decision model was tested which predicts the likelihood that: (a) an adult child is named as a helper by elder respondents who have at least one living child; (b) an adult child is chosen as the primary helper in networks including at least one adult child; and (c) among those networks containing at least one son and one daughter (one of whom was named as the primary helper), a son is selected rather than a daughter as the primary helper. The analysis revealed the importance of geographic proximity in predicting the involvement of adult children in parental helping networks. The integral role of daughters and other female family members was also highlighted. Other factors, such as parents' marital status, gender, level of functional impairment, and family structure, were also examined.
Siblings as Caregivers for Impaired Elders
Authors: Cicirelli Victor G. , Coward Raymond T. , Dwyer Jeffrey W.
Published: March 2007

Most older people regard their siblings as a caregiving resource, but only small percentages actually receive sibling help. The purpose of the present study was to determine what elder characteristics are associated with receiving sibling care, and what causes its initiation and cessation over time. Using longitudinal data from the 1982-1984 National Long Term Care survey, 293 elders were identified who received sibling help in either 1982, 1984, or both, and 146 elders were sampled who received no sibling help at either time period. The elder characteristics examined were age, gender, race, education, income, marital status, number of living children, perceived health, and ADL and IADL impairments. In LOGIT analyses, those receiving sibling help at Time 1 were more likely to be younger, to be maritally disrupted or never married, to have fewer living children, and to reside in small cities. Those reporting the onset of help by Time 2 were more likely to be younger, never married, and living in rural areas, and those reporting cessation of help were more likely to be older, to have a decrease in IADL impairment, and to have changed their area of residence. The findings support the concept of a substitution hierarchy where sibling help is given when the elder has functional impairments and support from a spouse or adult children is unavailable.
Acquiring the Family Eldercare Role
Authors: Franklin Susan T. , Ames Barbara D. , King Sharon
Published: March 2007

This study examined the influence of eldercare on three types of employment adaptation at two time periods. The adaptations included short-term work adjustments, leave of absence, and leaving the workplace at Time 1, and three months later, at Time 2. The influence of characteristics of the caregiver, care recipient, family support, and caregiver involvement variables on adaptations was investigated. Women who were employed full-time or part-time prior to caregiving reported substantial changes in that status at Time 1. Caregivers used fewer adaptive employment behaviors at Time 2 than at Time 1. Different sets of predictor variables were found to influence the types of employment adaptations at Time 1 and Time 2. Contrary to expectations, the use of short-term work adjustments at Time 1 did not influence the probability of a caregiver taking either a leave of absence or leaving the workplace at Time 2. Implications for research, practice, and policy are reviewed.
Primary Care Physicians' Diagnostic, Management, and Referral Practices for Older Persons and Families Affected by Dementia
Authors: Fortinsky Richard H. , Leighton Al , Wasson John H.
Published: March 2007

As the size of the older population increases, primary care physicians can expect to see growing numbers of patients who present with symptoms of cognitive dysfunction. This study examines how office-based primary care physicians in three states (N = 498) diagnose and manage dementia symptoms using clinical vignettes portraying a 72-year-old woman with either mild or moderate dementia symptoms and her adult daughter. Physicians were more likely to order a variety of laboratory tests than to perform mental and cognitive status tests as part of a diagnostic workup. Respondents also were much more likely to disclose a diagnosis of probable Alzheimer's disease to the daughter in the vignette than to her mother. Differences in reported dementia management behaviors were found according to physician specialty, number of years in practice, and experience with patients with dementia in actual practice. Results suggest that whereas primary care physicians can play a valuable role in the service system for families affected by dementia, barriers must be overcome to improve specific aspects of their diagnostic and management behaviors.
The STAYWELL Program-Maximizing Elders' Capacity for Independent Living Through Health Promotion and Disease Prevention Activities
Authors: Brice Gary C. , Gorey Kevin M. , Hall Rose Marie , Angelino Sharon
Published: March 2007

The STAYWELL Program, an 8-session health promotion/disease prevention pro-gram for older adults, was found to have a significant impact on elder participants' health-related beliefs and behaviors. This quasi-experimental study's 146 participants were recruited from 8 western New York senior citizen centers, and 70% (n = 102) were available for a 9-month follow-up assessment. As compared with elders on a waiting list, study participants who experienced the STAYWELL intervention ex-pressed significantly healthier beliefs and reported behavioral changes indicative of a healthier lifestyle at follow-up. All of the intervention effect sizes observed may be characterized as large to very large: (1) The intervention group expressed healthier beliefs as assessed using the healthy belief index-at follow-up, three quarters of them scored higher on this measure than the average person in the waiting list comparison group (U3 = 77.3%); (2) the intervention group engaged in healthier behaviors as assessed by using the healthy behavior index (U3 = 92.4%); and (3) they also took fewer medications (U3 = 74.2%); all p < .05. Extant cohorts in this field (more than 20,000 elders) may offer collaborative opportunities for needed longer follow-up of health outcome end-points.
The Perceptions of Elderly Parents about the Possibility of Discontinuing their Coresidence with Adult Children
Authors: Coward Raymond T. , Albrecht Stan L. , Shapiro Adam
Published: March 2007

In the United States, it is not uncommon for older adults (age 65 years or over) to live in the same households with adult children. Yet we know very little about the quality and dynamics of the interpersonal relationships within such households. In this investigation, older adults (N= 192) coresiding with adult children respond to a series of hypothetical questions about how their lives might change if they no longer lived with those children. Results indicate that the majority of parents anticipate no change in most aspects of their lives. Among those who anticipate a change, most indicate that their lives would be worse. Bivariate comparisons identify parent, child, and household characteristics that are associated with more negative expectations; however, in multivariate analyses, the marital status of the parents had the most significant and pervasive influence on the attitudes that were expressed, with unmarried elders more likely to anticipate a negative impact.
Explaining Retirement Decisions of Civil Servants in the Netherlands
Authors: Henkens Kene , Tazelaar Frits
Published: March 2007

International literature on early-retirement decisions concentrates either on determinants of retirement attitudes and intentions or on determinants of retirement behavior. This study focuses on determinants of retirement behavior, analyzes whether retirement intentions are a proximate determinant of retirement behavior, and examines how a discrepancy between the two can be explained. Data have been analyzed from a survey conducted among Dutch civil servants who were less than 1 year from the moment of eligibility for early retirement. The authors conclude that the opportunity structure and the evaluation of the perceived consequences of early retirement are important in the early-retirement decision-making process. They also conclude that intentions with respect to early retirement only partly take into account the social consequences of retirement and the perceived social support of the partner.
Support Network Type and Health Service Utilization
Authors: Litwin Howard
Published: March 2007

A secondary analysis of data from a national survey of elderly people in Israel applied a quick clustering procedure to a set of relational and interactional variables to derive a typology of support networks. The procedure produced six network types significantly differentiated by the gender, age, education, years of residence in the country, and health status of the focal elders in the network. They are characterized respectively as (1) diversified, (2) friend and family, (3) narrow family focused, (4) attenuated, (5) religious family focused, and (6) traditional extended family support networks. Respondents in the different network types were found to have differing degrees of health service utilization, as measured on a combined index of nine health services. The healthiest respondents with the most diversified support networks made the greatest use, and those with family-focused networks made the least use of health services.
Self-Management of Heart Disease by Older Adults
Authors: Clark Noreen M. , Janz Nancy K. , Dodge Julia A. , Schork M. Anthony , Wheeler John R. C. , Liang Jersey , Keteylan Steven J. , Santinga John T.
Published: March 2007

A randomized, controlled trial involving 636 older individuals was conducted to evaluate an intervention to enhance self-management of heart disease. Program participants experienced less impact of illness on their psychosocial functioning (p <.05), especially their emotional behavior (p < .05) and alertness (p < .01). Compared to controls, male program participants experienced improvements in their physical functioning, specifically their ability to ambulate (p < .05) and the frequency and severity of their symptoms. Female program participants did not experience gains in physical functioning. Most group differences emerged by 12 months and decayed by the 18-month final evaluation. To accurately assess the pattern of change associated with a program of this type, evaluation over at least 18 months following program completion may be needed. Separate interventions for older men and women with heart disease appear warranted, as do follow-up activities at strategic points in time to sustain program effects.
Middle-Aged and Older People with AIDS
Authors: Ory Marcia G. , Mack Karin A.
Published: March 2007

This article explores the stability and changes in national trends related to AIDS rates, transmission routes, and risk factors from the mid-1980s to 1997. The authors show that while the numbers of AIDS cases have grown dramatically for all age groups, the proportion of cases for persons age 50 and older (at diagnosis) has remained a fairly stable 10% of the total case load, resulting in more than 60,000 cases in 1997. Contrary to popular belief, the most prevalent transmission route for middle-aged and older people has always been through sexual contact. While middle-aged and older people may be at reduced risk compared to younger age groups, these data also reveal a disturbing trend. People age 50 and older continue to be less knowledgeable about AIDS risks, perceive themselves to be at lower risk, and, for those with known AIDS-related risks, have made fewer behavioral accommodations to avoid such risksas compared to younger people. With recent data indicating a faster rise in new AIDScases among the 50-plus population, middle-aged and older people can no longer beignored in AIDS prevention or treatment efforts.
Aging and Informal Caregiving to People with HIV/AIDS
Authors: Mullan Joseph T.
Published: March 2007

This article reviews the growing research dealing with informal caregivers to peoplewith HIV infection or AIDS, focusing particularly on the intersection of this workwith research on aging. It contrasts AIDS caregiving with what is known aboutcaregiving in general, which is often associated with caring for a frail older person.This comparison points to a scholarly literature in which aging, gender, generationaldifferences, and life-course issues have been a central concern. In addition, using datafrom the UCSF Care Study, this article presents some results from analyses concernedspecifically with the interpretation of age-related effects and caregiving. It emphasizesthe diversity among AIDS caregivers, who may be friends, partners, or familyrelatives, and the diversity of their experiences with caregiving, loss, and aging. Italso outlines important methodological and conceptual links between a life-courseperspective on aging and AIDS caregiving and suggests how each scholarly concernmay inform the other.
Ethnic Differences in Time Transfers from Adult Children to Elderly Parents
Authors: Wong Rebeca , Kitayama Kathy E. , Soldo Beth J.
Published: March 2007

This article examines differences across racial-ethnic groups in patterns of time transfers from middle-aged adult children to their elderly parents and the degree to which heterogeneity in unobserved family-level factors may explain observed differences. Using data from the 1992 Health and Retirement Study (HRS) on respondents and their siblings, the analysis supports the hypothesis that the determinants of time assistance vary across racial-ethnic groups: Controlling for socioeconomic attributes of potential donors and the recipient, there is evidence of unobserved family-level heterogeneity for Whites and Blacks but not for Hispanics.
Multi-Item Scales for Measuring Global Self-Rated Health
Authors: Bjorner Jakob Bue , Kristensen Tage SØndergaard
Published: March 2007

The authors used multigroup confirmatory factor analysis and structural equations models to examine the construct validity and item functioning of the five-item General Health (GH) scale from the SF-36 in Danes over 16 years of age ( n = 4,084). They included four criteria variables for physical and mental health. Items GH2-GH5 had low response rates among the elderly, probably due to the compact layout of these items in the questionnaire. The authors found differential item functioning for several items, indicating some degree of multidimensionality in the GH scale. Thus, GH1 had stronger associations with age, physical functioning, and chronic diseases than predicted by the one-factor model. However, psychometrical problems were mostly found in the youngest age group. If the problem of missing values is solved by layout changes or interview administration, the GH scale appears to be a valid measure of self-rated health in elderly populations.
Information, Gouvernance et Développement Durable
Authors: Brodhag Christian
Published: March 2007

L'Agenda 21 de Rio accorde une place importante à l'information. L'article montre comment la vision du rôle de l'information diffère selon les parties de l'Agenda. Les deux premières parties consacrées aux thémes techniques considèrent surtout une information descendante depuis les niveaux internationaux et nationaux vers les niveaux locaux. En revanche, la troisième partie qui traite des acteurs établit un droit d'accès à l'information. Enfin, le dernier chapitre, qui traite spécifiquement de ce thème, considère que chacun est utilisateur et fournisseur d'information. L'auteur considère nécessaire de mobiliser l'information au cour de la décision car elle est un élément majeur de la gouvernance. Elle doit être mise en ouvre localement, proche des niveaux opérationnels. Elle doit non seulement circuler de haut en bas (top down) et de bas en haut (bottom up) mais aussi de façon horizontale au sein de réseaux d'échange d'expériences. Enfin il faut tenir scrupuleusement compte des barrières linguistiques et respecter la richesse apportée par le multilinguisme. Les opportunités offertes par Internet doivent être mises en ouvre dans ces objectifs notamment par l'utilisation de systèmes de méta-information (protocoles, thesaurus_), et le développement de centres de ressource locaux_
The Comparative Study of Electoral Governance—Introduction
Authors: Mozaffar Shaheen , Schedler Andreas
Published: March 2007

Electoral governance is a crucial variable in securing the credibility of elections in emerging democracies, but remains largely ignored in the comparative study of democratization. This article develops some basic analytical tools to advance comparative analysis and understanding of this neglected topic. It conceptualizes electoral governance as a set of related activities that involves rule making, rule application, and rule adjudication. It identifies the provision of procedural certainty to secure the substantive uncertainty of democratic elections as the principal task of electoral governance. It argues that electoral governance, while socially and institutionally embedded, matters most during the indeterminate conditions that typically attend democratization. Finally, it outlines a research agenda that covers the comparative study of the structures as well as the processes of electoral governance.
Comparing Business and Public Interest Associability at the International Level
Authors: Kellow Aynsley
Published: March 2007

The increasing importance of globalization has made representation in international arenas more important. Yet key factors affecting associability of business and public interest groups at that level are markedly different from those which apply at the level of the nation-state. This article will argue that the “privileged position of business” does not obtain at the transnational level, and that business frequently prefers the national route. ngos, on the other hand, enjoy greater influence international than they do at the national level, essentially because of the ways in which they can assist international organizations to overcome their governance deficits. Examining sectors such as chemicals and biotechnology, this article explores the factors affecting associability at the international level and suggests some consequences which follow from these observations for the development of policy in international arenas.
Anticipating the Institutional Consequences of Expanded Membership of the European Union
Authors: De Witte Bruno
Published: March 2007

The coming Eastern enlargement of the European Union is seen by governments of the present member states, and by eu institutions, as threatening the eu institutional system's capacity to act, more so than any of the preceding enlargements. This article explores the origins of this concern, examines the way the eu states have sought to address it by means of treaty reforms (the last of which was agreed by the Nice European Council of December 2000), and addresses some other institutional challenges that should be dealt with before enlargement occurs.
Canada: Three Decades of Periodic Federal Crises
Authors: Watts Ronald L.
Published: March 2007

During the past three decades Canada has experienced four periods of major constitutional crisis, each of which has involved intense and contentious deliberations and debate over restructuring the federation. These resulted in only partial success in 1982 and total failure in the others. In most cases the periods of crisis have been followed by periods of exhausted quiescence before the fundamental structural problems of the federation have led once more to another effort to achieve comprehensive constitutional change. The explanation of these repeated crises cannot be attributed to one single factor but rather to a number of factors simultaneously reinforcing each other, and to the difficulties of attempting comprehensive rather than incremental constitutional restructuring where so many varied interests have to be reconciled at the same time in a process involving public participation.