bluuebunny/crossref_metadata_2025 huggingface dataset:
Perceived barriers and facilitators to implementing research findings in the Irish practice setting
Authors: Glacken Michèle , Chaney David
Published: August 2004

Background.  Studies have consistently demonstrated that nurses are increasingly recognizing the role research has to play in their daily practice. Despite this recognition the actual application of research findings in the practice setting is still poor. To date, the barriers to implementing research findings in the Republic of Ireland's practice setting have not been explored empirically. This study sought to address this gap.

Aims.  The aims of this study were to ascertain what Registered Nurses practising in the Republic of Ireland perceive as barriers to the implementation of research findings in the practice setting and to explore what they perceive would facilitate them in using research findings in their daily practice.

Design.  Cross‐sectional survey.

Methods.  A non‐probability strategy was employed with all Registered Nurses who commenced a nursing‐focused academic course accredited by the University of Dublin, Trinity College, between September 2001 and February 2002 invited to participate. The ethical rights of the participants in terms of anonymity, privacy and informed consent were assured through a number of mechanisms. Data were collected via the Barriers scale.

Findings.  Eight of the top 10 ranked barriers were organization centred. The top barrier was a perception of insufficient authority to instigate change in the practice setting. The perceived key facilitators to implementing research findings included protected time for retrieval and evaluation of research findings, instrumental support from management, informed supportive personnel in the practice settings and accessible educational opportunities to augment critical reading skills.

Relevance to clinical practice.  The Irish Government is committed to provide the people of Ireland with an evidence‐based health service. From a nursing perspective the findings of this study indicate that a number of strategies have to be introduced or enhanced in the practice settings before this commitment can be realized.
Nursing home residents’ dependence and independence
Authors: Stabell Aase , Eide Hilde , Solheim Gunnel Anita , Solberg Kari Nässelqvist , Rustøen Tone
Published: August 2004

Background.  Entering an institution constitutes one of the most difficult developmental challenges for older people, and may lead to increased dependency because of reinforcing environmental events such as the interaction pattern of the staff.

Aims and objective.  The aim of this paper was to describe the pattern of social interaction between nursing home residents and the nursing staff during mealtimes.

Design and methods.  Six residents of a nursing home in a suburb of Oslo were observed. Data were collected during 120 systematic observations. Different types of behaviour relating to the residents’ level of independence when interacting with the staff were examined using a structured observational scheme developed by Baltes.

Results.  Data showed that the residents’ maintenance of independent self‐care was the most predominant behaviour. Residents were rarely socially active. The behaviour of one resident varied among meals. Observations of independent self‐care maintenance during interactions between the residents and the staff were sometimes consistent and sometimes inconsistent. The response of the nursing staff to the residents’ social engagement was variable. Generally, however, they did not respond at all and seldom displayed engagement‐supportive behaviour.

Conclusions.  The results represent a challenge to the nursing staff to increase social interaction during mealtimes, and also to examine their inconsistent behaviour towards the residents.

Relevance to clinical practice.  Mealtime appears to be a good opportunity to foster the independence of the residents as well as to enhance social activity in the form of informal conversation. Greater consistency of staff behaviour is required, based on ethical values such as consideration of the residents’ self‐esteem and autonomy, thereby stimulating independent self‐care at mealtimes. Inconsistent behaviour, often based on values that are not clarified, may, on the contrary, lead to increased dependence of the residents.
Assertiveness and caring: are they compatible?
Authors: McCartan Patrick J , Hargie Owen DW
Published: August 2004

Background.  Findings from numerous assertion studies suggest that nurses are generally non‐assertive. This study examines the role of caring as an important determinant of adaptive assertive behaviour.

Aim and objectives.  The aim of the investigation was to explore the relationship between assertion and caring skills. Two study objectives sought to determine whether both positive and negative assertive behaviours were related to caring skills.

Design.  Correlational and cross‐sectional study.

Method.  The Caring Assessment Instrument (Care Q – Questionnaire Version) and the assertion inventory were used to collect self‐report data from a convenience sample of 94 subjects. Behavioural data were obtained by directly sampling 50 nurses’ responses within role‐play situations.

Results.  One significant result between the various assertion measurements and caring skill scores was noted, highlighting a relationship between negative assertion and the caring ‘accessible’ subscale.

Conclusion.  Overall the findings of the study suggest that positive and negative assertive behaviours are not related to caring skills.

Relevance to clinical practice.  The current findings suggest that the presence of caring attributes cannot be offered as a possible reason for non‐assertion in nurses.
Statin use in Type 2 diabetes mellitus is associated with a delay in starting insulin
Authors: Yee A. , Majumdar S. R. , Simpson S. H. , McAlister F. A. , Tsuyuki R. T. , Johnson J. A.
Published: August 2004

Aims  It has been suggested that HMG Co‐A reductase inhibitors (‘statins’) may reduce the risk of developing Type 2 diabetes mellitus. This study was designed to evaluate whether use of statins would also delay progression to insulin therapy.

Methods  This was a retrospective cohort study using Saskatchewan Health databases to identify subjects newly started on oral antidiabetic agents from 1991 to 1996.

Subjects  < 30 years of age or with previous lipid‐lowering drug use were excluded. Medications known to influence glycaemic control, co‐morbidity, and demographic data were collected. Statin exposure was defined as at least 1 year of use. Primary outcome was starting insulin treatment. Multivariate Cox proportional hazards models were used to examine the association between statin use and starting insulin.

Results  The final cohort included 10 996 new users of oral antidiabetic agents, of which 484 (4.4%) used statins. Mean age was 64 years and 55% were male. Mean duration of follow‐up was 5.1 years; 11.1% (n = 1221) eventually started insulin treatment. Statin users were no less likely than non‐users to start insulin treatment eventually (11.6% vs. 11.1%, P = 0.74). After multivariate adjustment, however, statin use was associated with a 10‐month delay before newly treated diabetic subjects needed to start insulin treatment (adjusted hazard ratio 0.74; 95% confidence interval 0.56, 0.97, P = 0.028).

Conclusion  The use of statins is associated with a delay in starting insulin treatment in patients with Type 2 diabetes initially treated with oral antidiabetic agents. Whether this relationship exists for patients at high risk of developing diabetes should be examined in a randomized trial.
Effect of acute hyperglycaemia on sodium handling and excretion of nitric oxide metabolites, bradykinin, and cGMP in Type 1 diabetes mellitus
Authors: Šimková R. , Kazdová L. , Karasová L. , Simek S. , Pelikánová T.
Published: August 2004

Aims  The aim of this study was to evaluate the effect of acutely induced hyperglycaemia on renal sodium handling and to explore the role of the bradykinin‐nitric oxide‐cGMP signalling pathway.

Patients and methods  We compared 20 Type 1 diabetic (DM1) patients without microalbuminuria with 15 weight‐, age‐, and sex‐matched healthy controls (C). Clearances of para‐aminohippuric acid (CPAH), inulin (Cin), lithium, sodium, and urinary nitrite/nitrate (NOx), cGMP and bradykinin excretion rates were measured in two 90‐min periods: a glycaemic clamp‐induced euglycaemia (5 mmol/l—period I) and hyperglycaemia (12 mmol/l—period II) (Study 1) and during time‐controlled euglycaemia (5 mmol/l—period I and 5 mmol/l—period II) to avoid the effects of time and volume load (Study 2).

Results  Cin and CPAH were not significantly different during euglycaemia (period I of Study 1) in DM1 and controls, whereas fractional excretion of sodium was decreased in DM1 (1.84 ± 0.75 vs. 2.36 ± 0.67%; P < 0.05) due to an increase in fractional distal tubular reabsorption of sodium (94.01 ± 1.94 vs. 92.24 ± 2.47%; P < 0.05). A comparison of changes during Study 1 and Study 2 revealed acute hyperglycaemia did not change renal haemodynamics significantly, while fractional distal tubular reabsorption of sodium increased (DM1: P < 0.05; C: P < 0.01) and fractional excretion of sodium decreased (P < 0.01) in both groups. The urinary excretion rates of NOx were comparable during euglycaemia in DM1 and C. While in C, they significantly increased during Study 1 (period I: 382 ± 217 vs. period II: 515 ± 254 nmol/min; P < 0.01) and Study 2 (period I: 202.9 ± 176.8 vs. period II: 297.2 ± 267.5 nmol/min; P < 0.05) as a consequence of the water load, no changes were found in DM1. The urinary excretion of bradykinin was lower in DM1 compared with C (0.84 ± 0.68 vs. 1.20 ± 0.85 µg/min; P < 0.01) during euglycaemia; it was not affected by hyperglycaemia. There were no significant differences between DM1 and C and in cGMP urinary excretion rates following hyperglycaemia.

Conclusion  This study demonstrates that DM1 without renal haemodynamic alterations is associated with impaired renal sodium handling. Moreover, we did not find a relationship between the renal excretion rates of vasoactive mediators and sodium handling due to hyperglycaemia.
A single dose of nateglinide improves post‐challenge glucose metabolism and endothelial dysfunction in Type 2 diabetic patients
Authors: Shimabukuro M. , Higa N. , Takasu N. , Tagawa T. , Ueda S.
Published: August 2004

Aims  This randomized crossover placebo‐controlled study aimed to assess the efficacy of nateglinide, a phenylalanine‐derived insulin secretagogue, on forearm endothelial function in diabetic subjects before and after an oral glucose load.

Methods  Forearm blood flow (FBF) was measured using strain‐gauge plethysmography during reactive hyperaemia before and after an oral glucose load (75 g) with a prior use of placebo or nateglinide (90 mg) in 15 diet‐treated Type 2 diabetic patients or age‐matched controls with normal glucose tolerance.

Results  The peak FBF response and total reactive hyperaemic flow (flow debt repayment: FDR), indices of resistance artery endothelial function, were decreased after an oral glucose load in diabetic patients, but unchanged in controls. Nateglinide administered to diabetic patients accelerated insulin secretion and reduced post‐challenge plasma glucose, and also abolished the post‐challenge impairment of endothelial function. The peak FBF and FDR were well correlated with 120‐min glucose levels and 30‐min insulinogenic index.

Conclusions  A single challenge of glucose was shown to impair endothelial function in diabetic patients, and the post‐challenge endothelial dysfunction was improved by a prior use of nateglinide. Long‐term effects of nateglinide on endothelial function in Type 2 diabetic patients need to be clarified in future studies.
The number of unexpected HbA1c variants may be a greater problem in routine practice than is generally realized
Authors: Reynolds T. M. , Twomey P. J. , Harvey T. C. , Green B. N.
Published: August 2004

Background  The majority of variant and abnormal haemoglobins are clinically silent but may not be biochemically silent when it comes to HbA1c estimation.

Case report  We describe several cases in which there were problems in the determination of HbA1c for monitoring diabetes in patients that would not normally be classified as being at risk. Four of these cases were sufficiently unusual to warrant individual publication but all came from a very restricted geographical area with a population of only approximately 500 000. The significance of this is not that variant haemoglobins affect HbA1c analysis but that the occurrence of unexpected/unusual variant haemoglobins may be more frequent than most clinicians would expect, considering that only a small proportion of the basal population are diabetic and have their HbA1c monitored. Differences will exist between different areas due to differences in both the prevalence of variants and the analytical methods employed.

Conclusions  Consequently, we propose greater interaction between diabetologists and the laboratory in an attempt to identify these clinically but not biochemically silent variants to achieve a true estimation of the glycaemic control in affected patients.
Type 1 diabetes mellitus in childhood: a matched case control study in Lancashire and Cumbria, UK
Authors: Marshall A. L. , Chetwynd A. , Morris J. A. , Placzek M. , Smith C. , Olabi A. , Thistlethwaite D.
Published: August 2004

Aims  The aim of the study was to identify environmental risk factors for insulin‐dependent diabetes mellitus (Type 1 DM) in childhood.

Methods  A matched case‐control study of Type 1 DM conducted in Lancashire and Cumbria, UK, using a structured interview. Cases (n = 196, participation rate 83%) were children under 16 years of age diagnosed prior to October 1998 and attending diabetic clinics. Controls (n = 381) were healthy children from the community matched by gender and by age (within a few days of birth). The data were analysed by logistic regression using the technique of Breslow and Day for matched case control studies.

Results  The multivariate regression model showed that the following factors were significantly associated with the risk of developing Type 1 DM (odds ratio, 95% confidence intervals): sharing a room with a sibling (0.458, 0.290–0.721), social contact with other children when aged 6–11 months (0.439, 0.256–0.752), consumption of sugary food (0.080, 0.024–0.261), parental insulin dependent diabetes mellitus (10.651, 3.086–36.761), maternal thyroid disease (4.861, 1.681–14.058), consuming more than one pint of milk per day prior to school entry (0.498, 0.310–0.802), maternal smoking during pregnancy (0.373, 0.218–0.636), a father with no academic qualifications (0.504, 0.278–0.913), maternal age at time of birth (0.900, 0.854–0.948), maternal infections in pregnancy (2.453, 1.011–5.948), other maternal illnesses or conditions in pregnancy (2.007, 1.139–3.535), belonging to an Asian family (0.104, 0.028–0.394), and regular contact with pets and other animals (0.552, 0.309–0.987).

Conclusion  Many of the results are consistent with the hygiene hypothesis which links improved living standards with decreased exposure to microorganisms and increased risk of immune mediated disease in childhood. These findings challenge the idea that improved hygiene acts exclusively through a Th2 mechanism leading to atopic disease as Type 1 DM is mediated by a Th1 reaction. The association with maternal smoking could be due to recall bias but a causal link cannot be excluded with confidence.
Metabolic, immunological and clinical characteristics in newly diagnosed Asian diabetes patients aged 12–40 years
Authors: Pan C. Y. , So W. Y. , Khalid B. A. K. , Mohan V. , Thai A. C. , Zimmet P. , Cockram C. S. , Jorgensen L. N. , Yeo J. P. ,   The ASDIAB Study Group
Published: August 2004

Aim  To describe the clinical, biochemical and immunological characteristics of young‐onset diabetes in Asia.

Methods  Clinical, biochemical and immunological variables were assessed in 919 newly diagnosed (duration less than 12 months) young onset Asian diabetic patients aged between 12 and 40 years. The subjects constituted 57% Chinese, 29% Indians and 14% Malays, recruited from diabetes centres in China, Hong Kong, India, Malaysia and Singapore.

Results  The mean age (± sd) was 31.6 ± 7.2 years, with the majority (66%) in the 31–40 years age group. Mean body mass index (BMI) (± sd) was 25.3 ± 5.0 kg/m2 with 47% exceeding the suggested Asian cut‐off point for obesity (BMI ≥ 25). Ethnic difference in clinical characteristics included BMI, blood pressure, mode of treatment and degree of insulin resistance. Most patients had a clinical presentation of Type 2 diabetes. About 10% had a classical combination of ketotic presentation, presence of autoimmune‐markers and documented insulin deficiency indicative of Type 1 diabetes. Forty‐eight percent were receiving oral hypoglycaemic agents (OHAs) while 31% were on diet only, 18% were receiving insulin and 2% were on a combination of insulin and OHA.

Conclusion  Young onset diabetes patients in Asia represent a heterogenous group in terms of their clinical and biochemical characteristics and classical Type 1 diabetes is relatively uncommon. The 5‐year follow up study will determine the progress of these patients and help to clarify the natural history.
HMG‐CoA reductase inhibitors prevent bone loss in patients with Type 2 diabetes mellitus
Authors: Nakashima A. , Nakashima R. , Ito T. , Masaki T. , Yorioka N.
Published: August 2004

Aims  It has been reported that 3‐hydroxy‐3‐methylglutaryl co‐enzyme A (HMG‐CoA) reductase inhibitors increase bone mineral density (BMD) in vivo. We investigated the effect of HMG‐CoA reductase inhibitors on BMD in patients with Type 2 diabetes mellitus.

Patients and methods  We selected 122 patients with Type 2 diabetes, who were not taking active vitamin D preparations. Their mean age was 67.3 ± 9.2 years. They were divided into a control group (n = 63) without HMG‐CoA reductase inhibitor therapy and an HMG‐CoA group (n = 59) who were treated with these drugs. The BMD of the distal one‐third of the radius was measured by dual‐energy X‐ray adsorptiometry at baseline and after 2 years.

Results  There were no significant differences between the control and HMG‐CoA groups at baseline with respect to age, gender, body mass index, duration of diabetes, haemoglobin A1c, fasting plasma glucose, adjusted calcium, serum phosphorus, alkaline phosphatase, albumin excretion rate and radial BMD. However, there was a significantly smaller annual decrease of the radial BMD in the HMG‐CoA group. Multiple regression analysis with a forward elimination procedure revealed a positive correlation of the radial BMD Z‐score with body mass index, while there was a negative correlation with alkaline phosphatase and albumin excretion rate. In addition, the annual rate of change of the radial BMD showed a positive correlation with HMG‐CoA reductase inhibitor therapy.

Conclusions  These findings suggest that HMG‐CoA reductase inhibitors may prevent bone loss in patients with Type 2 diabetes.
The effect of diabetes on heart rate and other determinants of myocardial oxygen demand in acute coronary syndromes
Authors: Foo K. , Sekhri N. , Knight C. , Deaner A. , Cooper J. , Ranjadayalan K. , Suliman A. , Timmis A. D.
Published: August 2004

Aims  To compare major determinants of myocardial oxygen demand (heart rate, blood pressure and rate pressure product) in patients with and without diabetes admitted with acute coronary syndromes.

Methods  A cross‐sectional study of the relation between diabetes and haemodynamic indices of myocardial oxygen demand in 2542 patients with acute coronary syndromes, of whom 1041 (41.0%) had acute myocardial infarction and 1501 (59.0%) unstable angina.

Results  Of the 2542 patients, 701 (27.6%) had diabetes. Major haemodynamic determinants of myocardial oxygen demand were higher in patients with than without diabetes: heart rate 80.0 ± 20.4 vs. 75.2 ± 19.2 beats/minute (P < 0.0001); systolic blood pressure 147.3 ± 30.3 vs. 143.2 ± 28.5 mmHg (P = 0.002); rate‐pressure product 11533 ± 4198 vs. 10541 ± 3689 beats/minute × mmHg (P < 0.0001). Multiple regression analysis confirmed diabetes as a significant determinant of presenting heart rate [multiplicative coefficient (MC) 1.05; 95% confidence interval (CI) 1.03–1.07; P < 0.0001], rate pressure product (MC 1.09; CI 1.05–1.12; P < 0.0001) and systolic blood pressure, which was estimated to be 3.9 mmHg higher than in patients without diabetes (P = 0.003). These effects of diabetes were independent of a range of baseline variables including acute left ventricular failure and mode of presentation (unstable angina or myocardial infarction).

Conclusions  In acute coronary syndromes, heart rarte and other determinants of myocardial oxygen demand are higher in patients with than without diabetes, providing a potential contributory mechanism of exaggerated regional ischaemia in this high‐risk group.
CONTOURS OF AN ANTHROPOLOGY OF THE CHINESE STATE: POLITICAL STRUCTURE, AGENCY AND ECONOMIC DEVELOPMENT IN RURAL CHINA
Authors: Pieke Frank N.
Published: August 2004

Anthropologists have long been inclined to view China from the perspective of a state‐society dichotomy. In this model, the inevitable consequence of economic reform is that – especially at the local level – the state must yield more and more of its power to entrepreneurs, foreign investors, non‐state organizations, and local communities. Not only does this approach distort the role of the state in society, but by placing the state above and outside society it also excludes it from the anthropological gaze. This article proposes an anthropology of the Chinese state which does not merely view the state in society, but also investigates the state itself as society. Drawing on fieldwork in northeastern Yunnan province, I illustrate this general point by investigating the changing role of the local state in economic development. This agenda for an anthropology of the Chinese state resonates both with the recent ‘reinvention’ of the subfield of political anthropology with its focus on governmentality, policy, and rights, and with recent calls by political scientists for the development of an interdisciplinary anthropology of the developmental state.
CONSULTING KU JLOPLE: SOME HISTORIES OF ORACLES IN WEST AFRICA
Authors: Tonkin Elizabeth
Published: August 2004

Historical comparison of oracles in west Africa, mainly during the nineteenth century, shows how divination practices may alter. In the cases explored here, reputation, range of users, economic growth, and political influence interacted as these oracles developed; some at sites with internal and overseas trade access became complex, large‐scale operations. But by about 1900, colonialists felt threatened by their secular and their spiritual power and smashed them physically, though not spiritually. Contextualized comparison shows that the many people who were involved as oracle organizers and supplicants must have had different motivations and interests. Some methodological implications of the findings are considered. As in many powerful secular organizations, access to insider knowledge was blocked, but oracular reputation was important, and the oracles had competitors. Success derived partly from collecting intelligence, with simultaneous advertisement that emphasized the mysterious power of their operations.
NOT ANIMAL, NOTNOT‐ANIMAL: HUNTING, IMITATION AND EMPATHETIC KNOWLEDGE AMONG THE SIBERIAN YUKAGHIRS
Authors: Willerslev Rane
Published: August 2004

Among the Yukaghirs, a small group of indigenous hunters in northeastern Siberia, it is commonly held that humans and animals can turn into each other by temporarily taking on one another's bodies. However, this is dangerous for a hunter, because he may thus lose sight of his original species identity and undergo an irreversible metamorphosis. He therefore assumes the viewpoint of his prey, but not in any absolute sense, which would mean literally becoming the animal. This article explores the mimetic practice that allows the hunter to be similar to the animal impersonated, yet also different, giving him a ‘double perspective’ by which he can seduce and kill his prey.
CONSTRUCTING PREHISTORY: LITHIC ANALYSIS IN THE LEVANTINE EPIPALAEOLITHIC
Authors: Pirie Anne
Published: August 2004

This study explores the way in which our picture of the Levantine Epipalaeolithic has been created, investigating the constructs that take us from found objects to coherent narrative about the world. Drawing on the treatment of chipped stone, the fundamental raw material of prehistoric narratives, it examines the use of figurative devices – of metaphor, metonymy, and synecdoche – to make the connection between the world and the words we need to describe it. The work of three researchers is explored in a case study of the Middle Epipalaeolithic with the aim of showing how different research goals and methodologies have created characteristics for the period that are so entrenched in discourse as to have become virtually invisible. Yet the definition of distinct cultures with long‐lasting traditions, the identification of two separate ethnic trajectories linked to separate environmental zones, and the analysis of climate as the key driver of change all rest on analytical manoeuvres to transform objects into data.
The trade union response to agency labour in Britain
Authors: Heery Edmund
Published: August 2004

The growth of agency work in recent years has posed a challenge to trade unions, which must decide if they will accept agency workers as part of their constituency and accept employment agencies as legitimate labour‐market actors. This article analyses the reaction of British unions to agency work and identifies four main responses: exclusion, replacement, regulation and engagement. It concludes with an evaluation of union policies, which stresses the need for unions to secure broad regulation of the agency labour market either through multi‐employer bargaining or employment law.
Individualism and collectivism revisited: a study of black and minority ethnic women
Authors: Healy Geraldine , Bradley Harriet , Mukherjee Nupur
Published: August 2004

This article seeks to add discussion of the intersection of gender and ethnicity to the debates on individualism and collectivism. In doing so, it challenges the prevailing view, in these debates, of the rise of individualism and the decline in collectivism. Through a study of black and minority ethnic women trade unionists, it shows how a differentiated workforce, rather than leading to individualism at work, may contribute to union renewal and inspire more creative forms of collectivism.
Electrophysiological evidence for delayed mismatch response in infants at‐risk for specific language impairment
Authors: Friedrich M. , Weber C. , Friederici A. D.
Published: August 2004

The present study investigated whether delayed auditory processing typically found in children with specific language impairment (SLI) can already be observed in the event‐related potentials of 2‐month‐old infants. Infants with and without a family history of SLI were tested in a passive auditory oddball paradigm with CV‐syllables differing in vowel duration. For the long syllable, a positive mismatch response occurred in the difference wave between deviant and standard. Its amplitude was higher in infants during quiet sleep than in awake infants, although its peak latency remained unaffected by alertness. Awake infants showed an adultlike mismatch negativity preceding the positivity. Risk for SLI was reflected in the latency of the positive mismatch response, which was delayed in infants with risk compared to infants without risk. This latency difference suggests that 2‐month‐old infants at risk for SLI are already affected in processing an auditory stimulus change of duration.
Effects of reward and stimulus modality on stimulus‐preceding negativity
Authors: Ohgami Yoshimi , Kotani Yasunori , Hiraku Shiho , Aihara Yasutsugu , Ishii Motonobu
Published: August 2004

The present study aimed to investigate the effect of reward and stimulus modality of feedback stimuli on the stimulus‐preceding negativity. A time estimation task was performed, and (a) the motivational level (reward and no‐reward) and (b) the stimulus modality (auditory and visual) of feedback stimuli were manipulated. The results demonstrated that the stimulus‐preceding negativity was larger in the reward than in the no‐reward condition, especially at the right frontal and the left occipito‐temporal areas. Moreover, the stimulus‐preceding negativity prior to visual feedback stimuli was larger over the occipital areas than in the auditory condition. In contrast, at the prefrontal areas, the amplitude prior to auditory feedback stimuli was larger than in the visual condition. Our results revealed that the prefeedback stimulus‐preceding negativity was independently influenced by stimulus modality and motivation.
Sensitivity of medial frontal cortex to response and nonresponse conflict
Authors: West Robert , Bowry Ritvij , McConville Celine
Published: August 2004

The anterior cingulate cortex (ACC) holds a prominent place in models of the neural architecture supporting cognitive control and conflict processing. The findings of empirical and computational work lead to the prediction that the ACC is sensitive to response conflict and insensitive to nonresponse conflict. We tested this prediction in two experiments using event‐related brain potentials in combination with a task in which some trials included only nonresponse conflict and others included nonresponse and response conflict. A N450 associated with the activity of neural generators in the ACC and anterior frontal region was elicited on trials including only nonresponse and nonresponse and response conflict. This finding is inconsistent with the hypothesis that activation of the ACC is limited to response conflict and may identify one avenue of development in future applications of conflict theory.
Electrophysiological indices of orienting attention toward pain
Authors: Dowman Robert
Published: August 2004

This study examined the effects of orienting on two pain‐related components of the sural nerve‐evoked somatosensory evoked potential: the NDP (80–230 ms), which is generated in part by the anterior cingulate cortex (ACCc), and SP6 (280–340 ms). NDP and SP6 amplitudes were larger when subjects oriented their attention away from an invalidly cued location and toward the sural nerve pain than when their attention remained focused on the pain. These results and our earlier studies suggest that the ACCc activity generating the NDP is involved in detecting transient painful stimuli. This activity is enhanced when the pain occurs outside the focus of attention, and it may signal other brain areas that attention should be oriented away from its current focus and toward the pain. SP6 appears to be a pain‐evoked P3a event‐related potential, with an anterior component involved in orienting attention away from some other task and toward the pain, and an posterior component involved in evaluating the pain.
Letter to the Editor
Authors: Paul Louis
Published: August 2004

Editors Note: This department welcomes brief comments by our readers upon the journal, the contents of a particular article, or the family field in general.
Contrasting Approaches in Marital Counseling
Authors: Elderkin Bell John
Published: August 2004

My Aim in this paper is to look at the therapist‐marital couple relationship as a social system, and from this perspective to outline some aspects of the difference between treating a husband or wife as an individual patient and treating them together as a marital couple.

I will try to differentiate individual treatment and treatment of the marital pair on two dimensions: their respective use as sources of data about the marital relationship, for both therapy and research, and their potentialities for changing the marital interaction.
COMMENT
Authors: Bell John E.
Published: August 2004

The paper presented here is quite possibly the first description of family therapy as a method of treatment where the whole family is seen consistently together. It was read at a meeting of the Eastern Psychological Association in Boston, April 24, 1953. At that time Dr. Bell was Associate Professor of Psychology and Director of the Psychological Clinic at Clark University, Worcester, Massachusetts. He is currently Program Director, NIMH, Dept. of Health, Education and Welfare, Region IX, San Francisco, California.
Sociopolitical Activist or Conversational Partner? Distinguishing the Position of the Therapist in Narrative and Collaborative Therapies
Authors: Monk Gerald , Gehart Diane R.
Published: August 2004

In this article, we explore the similarities and differences of two contemporary family therapy approaches: narrative and collaborative therapies. These therapies are contrasted by describing positioning of the narrative practitioner as sociopolitical activist and the collaborative practitioner as conversational partner. The article begins with a brief overview of the two therapies. Subsequently, we outline their epistemological genealogies and the practice similarities that arise from the theoretical assumptions underpinning these therapies. The remainder of the article addresses the theoretical and therapeutic differences in narrative and collaborative approaches reflected in the positioning of therapist as either sociopolitical activist or conversational partner. While narrative and collaborative approaches share more similarities than differences in relation to their emphasis on the constitutive characteristics of language, focus on socioŕelational contexts, and critique of singular objective truths, prominence is given to the starker contrasts in narrative and collaborative understandings of politics, power, dialogue, and discourse. It is proposed that by outlining some provocative contrasts between narrative and collaborative approaches, new conversations and generative practices will emerge in the therapy room.
Relational Factors and Family Treatment Engagement among Low‐Income, HIV‐Positive African American Mothers
Authors: Mitrani Victoria B. , Prado Guillermo , Feaster Daniel J. , Robinson‐Batista Carleen , Szapocznik Jose
Published: August 2004

Clinically derived hypotheses regarding treatment engagement of families of low‐income, HIV‐positive, African American mothers are tested using univariate and multivariate logistic regression models. Predictors are baseline family relational factors (family support, mother's desire for involvement with family, and family hassles) and mother's history of substance dependence. The study examines a subsample of 49 mothers enrolled in a clinical trial testing the efficacy of Structural Ecosystems Therapy (SET). SET is a family‐based intervention intended to relieve and prevent psychosocial distress associated with HIV/AIDS. Participants in the subsample were randomly assigned to SET and attended at least two therapy sessions. Findings reveal that family relational factors predicted family treatment engagement (family support, p < 004; mother's desire for involvement with family, p < 008; family hassles, p < 027). Family support predicted family treatment engagement beyond the prediction provided by the other relational factors and the mother's own treatment engagement (p < 016). History of substance dependence was neither associated with family treatment engagement nor family support. Post hoc analyses revealed that family hassles (p < 003) and mother's desire for involvement with family (p < 018) were differentially related to family treatment engagement in low‐versus high‐support families. Implications for clinical practice and future research are discussed.
Ambiguous Loss and Disenfranchised Grief: The Impact of DNA Predictive Testing on the Family as a System
Authors: Sobel Susan , Cowan C. Brookes
Published: August 2004

DNA predictive testing to diagnose the presence of hereditary disease in asymptomatic individuals has become increasingly available. Information provided by these tests has implications for all relatives. In an exploratory study we examined the impact, from the family's perspective, of predictive DNA testing for Huntington disease on the family as a system. Central to their stories was a sense of loss and grief that was perhaps unique to the testing situation. The description of these losses is presented in the context of ambiguous loss as defined by Boss, disenfranchised grief as presented by Doka, and anticipatory grief as addressed by Rolland. These theories suggest clinical interventions that can be used by healthcare professionals to help families adjust to the psychosocial consequences of testing.

Death too is in the egg.

—Anne Sexton, All My Pretty Ones (1962, p.13)
The Effect of Social Network Intervention for Women with Rheumatoid Arthritis
Authors: Fyrand Live , Moum Torbjøsrn , Finset Arnstein , Glennås Anne
Published: August 2004

A partially‐controlled intervention study was performed. Female patients with rheumatoid arthritis (RA) were allocated to three groups: the network intervention group (n=104), the attention control group (n=85), and the no‐treatment control group (n=75). The network intervention consisted of an assessment session and a network meeting. Patients were assessed at baseline and approximately 10 and 18 months after the intervention. The network intervention group reported an increase in network size. Daily emotional support increased for the intervention patients compared with patients in the attention control group. The degree of social dysfunction was reduced for patients in the intervention group compared to patients in the no‐treatment control group. Furthermore, for single patients, the intervention significantly increased the social network size and improved both social functioning, and perceived overall health, compared to both control groups. The results suggest that the social needs of single patients should be given special attention in clinical settings.
Family Secrecy: A Comparative Study of Juvenile Sex Offenders and Youth with Conduct Disorders
Authors: Baker Amy J. L. , Tabacoff Risa , Tornusciolo Gabriel , Eisenstadt Marvin
Published: August 2004

The reported research was designed to compare adjudicated male juvenile sexual offenders and youth with conduct disorders on five aspects of family secrecy and deception twenty‐nine male juvenile sex offenders and 32 comparison youth from three child welfare agencies in New York State participated in the study. Research assistants, blind to the hypotheses of the study and status of the youth, coded agency records for five variables identified a priori as a basis of comparison. Analyses revealed that the two groups were different on three of the five and on the total number of items scored. Families of juvenile sex offenders told more lies, had more family myths, and were more likely to be involved in taboo behavior. Logistic regression revealed that this factor of family deception significantly increased the odds of sexual offending over and above other measures of family pathology. These data support the hypotheses of the study and have implications for both clinical practice and future research in this area.
Divorce Process Variables and the Co‐Parental Relationship and Parental Role Fulfillment of Divorced Parents
Authors: Baum Nehami
Published: August 2004

This study examines the association between two sets of divorce process variables, a initiation of and responsibility for the divorce and b) difficulty and duration of the legal procedure, and divorced spouses co‐parental relationship and parental functioning. In a random sample of 50 former couples, in Israel; findings showed that the longer and more conflictual the legal proceedings, the worse the co‐parental relationship in the view of both parents. They also showed that mothers' parental functioning was not significantly associated with any of the divorce variables, but fathers' were. The more responsibility the father assumed for the divorce and the more he viewed himself as the initiator, the more he fulfilled his parental functions. The findings are interpreted in the discussion, and their theoretical and practical implications considered.
A Categorical and Dimensional Perspective on Depression Within a Nonclinical Sample of Couples
Authors: Heene Els , Buysse Ann , Van Oost Paulette
Published: August 2004

The present study investigated the role of psychosocial variables that are indicators for depressive symptomatology within a couple. The variables chosen for this study were conflict communication, marital adjustment, attachment, attribution style, and personality trails—all potentially specific indicators. A global factor analysis on all our measures revealed that our individual and relational measures were stable findings. We wanted to compare a dimensional and categorical view of depression. First, we focused on the total nonclinical sample, considering depression on a continuum, and studying the selected characteristics along with the varying degree of depressive complaints. The results highlighted the importance of individual characteristics (neuroticism and life satisfaction) covarying with the level of depressive symptomatology in the nonclinical sample (n=186 couples). Second, in addition to this correlational design, we compared the group of most depressed subjects and their partners with a control sample (n=34). Both approaches pointed to the same conclusion, individual characteristics covaried with mild depression, whereas couple characteristics only came into the picture with a higher level of depressive complaints. The lowest levels of depressive complaints were associated with individual co‐morbidity only, whereas increasing complaints went along with additional relational complaints. Implications for assessment and future research are discussed.
Dialogue and Power: A Critical Analysis of Power in Dialogical Therapy
Authors: GUILFOYLE MICHAEL
Published: August 2004

This article explores the relationship between dialogue and power in the practice of dialogue‐oriented, “not‐knowing” forms of therapy. It is argued that power of a dynamic and reversible kind infuses much ordinary social dialogue, and that the joint processes of power and resistance work together to render an interaction dialogical. In contrast, in dialogical therapy, overt exercises of power threaten the interaction's dialogical status, and power is deferred and denied by the therapist through not‐knowing practices. A case study of Harlene Anderson's (1997) is used to illustrate that it is precisely power's presence that informs the practices of not‐knowing and uncertainty that characterize dialogical therapies. It is suggested that the not‐knowing therapist withholds aspects of his or her voice as a condition for dialogicity. Instead, special speaking arrangements are required, in which the therapist's not‐knowing is continuously communicated to the client, for the therapeutic, conversation to remain dialogical. Without these speaking arrangements, I argue that therapy moves toward monologue. Therapists inherit powerful speaking positions from the institutional and sociocultural context, and the rejection of power within therapy serves only to conceal this aspect of power, which nevertheless pervades the therapeutic relationship. Finally, it is suggested that power is a “common factor”—shared by all therapies—and that our status as “inheritors” of power needs to be included in our understanding of the therapeutic process. This expanded view of therapy requires the re‐theorization of dialogue, such that it includes, rather than excludes, considerations of power.
Client‐level Predictors of Adherence to MST in Community Service Settings
Authors: SCHOENWALD SONJA K. , HALLIDAY‐BOYKINS COLLEEN A. , HENGGELER SCOTT W.
Published: August 2004

This study examined the association of youth and family characteristics with therapist fidelity to an evidence‐based treatment provided in real world practice settings. Participants were 233 families that reported on the 66 therapists organized into 16 teams in nine organizations providing multisystemic therapy (MST). Therapist adherence ratings were lower for youths referred for both criminal offenses and substance abuse than for youths referred either for substance abuse or status offenses, and was negatively associated with pretreatment arrests and school suspensions. Adherence ratings were positively associated with educational disadvantage and caregiver‐therapist ethnic match and marginally positively associated with economic disadvantage. The findings suggest directions for future research on the implementation of evidence‐based treatments in community settings.
Narratives About Their Children by Mothers Hospitalized on a Psychiatric Unit
Authors: SAVVIDOU IONNIA , BOZIKAS VASILIS P. , HATZIGELEKI SOPHIA , KARAVATOS ATHANASIOS
Published: August 2004

The diagnosis of “mental illness” is accompanied by negative implications regarding a person's competence. Self‐and other‐descriptions about the “patient” are embedded within broader cultural and societal discourses, influencing his/her relationships. The parental role seems to be one of the most sensitive, especially for women. Mothers hospitalized in psychiatric units often have to separate themselves from their children either temporarily, during hospitalization, or permanently, after a loss of custody. However, many studies have shown that mothering remains important for them.

We interviewed 20 women, inpatients on a psychiatric unit and mothers of 3.5‐18‐year‐old children, recording their narratives about their children and exploring their thoughts and understanding of the concepts of motherhood and mental illness. We also explored the way in which the mother‐child dyad interacted with the family and its social context.

Most mothers had a consistent and coherent narrative about their children and they had certain expectations of them. The mother‐child bond was strong, even when the children had been removed from their mother's custody. However, mothers were facing great difficulties with their partner and with the broader family context. Also, the social discourses regarding mental illness, (e.g., violence and incapability for mothering), were extremely oppressive for these women. They felt that they were the victims of societal attitudes even before they became pregnant.

These findings suggest the importance of listening to the voices of these women; acknowledging their competence in the therapeutic context; involving them with their families, and in legal and social contexts; and in planning supportive programs for them.
The Open Dialogue Approach to Acute Psychosis: Its Poetics and Micropolitics
Authors: SEIKKULA JAAKKO , OLSON MARY E.
Published: August 2004

In Finland, a network‐based, language approach to psychiatric care has emerged, called “Open Dialogue.” It draws on Bakhtin's dialogical principles (Bakhtin, 1984) and is rooted in a Batesonian tradition. Two levels of analysis, the poetics and the micropolitics, are presented. The poetics include three principles: “tolerance of uncertainly,”“dialogism,” and “polyphony in social networks.” A treatment meeting shows how these poetics operate to generate a therapeutic a therapeutic dialogue. The micropolitics are the larger institutional practices that support this way of working and are part of Finnish Need‐Adapted Treatment, Recent research suggests that Open Dialogue has improved outcomes for young people in a variety of acute, severe psychiatric crises, such as psychosis, as compared to treatment as‐usual settings. In a nonrandomized, 2‐year follow up of first‐episode schizophrenia, hospitalization decreased to approximately 19 days; neuroleptic medication was needed in 35% of cases; 82% had no, or only mild psychotic symptoms remaining; and only 23% were on disability allowance.