bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive Decline in High‐Functioning Older Persons Is Associated with an Increased Risk of Hospitalization
Authors: Chodosh Joshua , Seeman Teresa E. , Keeler Emmett , Sewall Ase , Hirsch Susan H. , Guralnik Jack M. , Reuben David B.
Published: August 2004

Objectives: To examine hospital use for patients with evidence of cognitive decline indicative of early cognitive impairment.

Design: Medicare Part A hospital utilization data were linked to data from the MacArthur Research Network on Successful Aging Community Study to examine the association between baseline cognition and decline in cognitive function over a 3‐year period and any hospitalization over that same period.

Setting: New Haven, Connecticut, and East Boston, Massachusetts.

Participants: Subjects (N=598) were from two sites of the MacArthur Research Network on Successful Aging Community Study, a 7‐year cohort study of community‐dwelling older persons with high physical and cognitive functioning.

Measurements: Multivariate logistic regression was used to determine the association between any hospitalization over 3 years (1988–91) as the outcome variable and baseline cognitive function and decline in cognition over 3 years as primary predictor variables. Decline was based upon repeated (1988 and 1991) measures of delayed verbal recall and the Short Portable Mental Status Questionnaire (SPMSQ).

Results: Of 598 subjects, 48 died between 1988 and 1991. No baseline (1988) delayed recall scores or change in recall scores (1988–91) were associated with hospitalization. Although 48.2% declined on verbal memory scores, decline was not associated with risk of hospitalization. Of 494 subjects with complete 3‐year data, 31.2% declined at least one point on the SPMSQ, and 4.7% declined more than two points. Among individuals aged 75 and older at baseline, the adjusted odds ratio for hospitalization for those who declined more than 2 points compared with those who declined less was 7.8 (95% confidence interval=2.0–30.8).

Conclusion: Although specific memory tests were not associated with hospitalization, high‐functioning older persons who experienced decline in overall cognitive function were more likely to be hospitalized. Variation in baseline cognitive function in this high‐functioning cohort did not affect hospitalization, but additional research is needed to evaluate associations with other healthcare costs.
Effectiveness of a Group Outpatient Visit Model for Chronically Ill Older Health Maintenance Organization Members: A 2‐Year Randomized Trial of the Cooperative Health Care Clinic
Authors: Scott John C. , Conner Douglas A. , Venohr Ingrid , Gade Glenn , McKenzie Marlene , Kramer Andrew M. , Bryant Lucinda , Beck Arne
Published: August 2004

Objectives: To compare the effectiveness of Cooperative Health Care Clinic ((CHCC) group outpatient model for chronically ill, older health maintenance organization (HMO) patients) with usual care.

Design: Two‐year, randomized, controlled trial conducted with recruitment from February 1995 through July of 1996.

Setting: Nonprofit group model HMO.

Participants: Two hundred ninety‐four adults (145 intervention and 149 usual care), aged 60 and older (mean age 74.1) with 11 or more outpatient visits in the prior 18 months, one or more self‐reported chronic conditions, and expressed interest in participating in a group clinic.

Intervention: Monthly group meetings held by patients' primary care physicians.

Measurement: Differences in clinic visits, inpatient admissions, emergency room visits, hospital outpatient services, professional services, home health, and skilled nursing facility admissions; measures of patient satisfaction, quality of life, self‐efficacy, and activities of daily living (ADLs).

Results: Outpatient, pharmacy services, home health, and skilled nursing facility use did not differ between groups, but CHCC patients had fewer hospital admissions (P=.012), emergency visits (P=.008), and professional services (P=.005). CHCC patients' costs were $41.80 per member per month less than those of control patients. CHCC patients reported higher satisfaction with their primary care physician (P=.022), better quality of life (P=.002), and greater self‐efficacy (P=.03). Health status and ADLs did not differ between groups.

Conclusion: The CHCC model resulted in fewer hospitalizations and emergency visits, increased patient satisfaction, and self‐efficacy, but no effect on outpatient use, health, or functional status.
Group Treatment Improves Trunk Strength and Psychological Status in Older Women with Vertebral Fractures: Results of a Randomized, Clinical Trial
Authors: Gold Deborah T. , Shipp Kathy M. , Pieper Carl F. , Duncan Pamela W. , Martinez Salutario , Lyles Kenneth W.
Published: August 2004

Objectives: To assess whether group exercise and coping classes reduce physical and psychological impairments and functional disability in older women with prevalent vertebral fractures (VFs).

Design: Randomized, controlled trial (modified cross‐over) with site as unit of assignment; testing at baseline and 3, 6, 9, and 12 months.

Setting: Nine North Carolina retirement communities.

Participants: One hundred eighty‐five postmenopausal Caucasian women (mean age 81), each with at least one VFs.

Intervention: The intervention group had 6 months of exercise (3 meetings weekly, 45 minutes each) and coping classes (2 meetings weekly, 45 minutes each) in Phase 1, followed by 6 months of self‐maintenance. The control group had 6 months of health education control intervention (1 meeting weekly, 45 minutes) in Phase 1, followed by the intervention described above.

Measurements: Change in trunk extension strength, change in pain with activities, and change in psychological symptoms.

Results: Between‐group differences in the change in trunk extension strength (10.68 foot pounds, P<.001) and psychological symptoms (−0.08, P=.011) were significant for Phase 1. Changes in pain with activities did not differ between groups (−0.03, P=.64); there was no change in the pain endpoint. In Phase 2, controls showed significant changes in trunk strength (15.02 foot pounds, P<.001) and psychological symptoms (−0.11, P=.006) from baseline. Change in pain with activities was not significant (−0.03, P=.70). During self‐maintenance, the intervention group did not worsen in psychological symptoms, but improved trunk extension strength was not maintained.

Conclusion: Weak trunk extension strength and psychological symptoms associated with VFs can be improved in older women using group treatment, and psychological improvements are retained for at least 6 months.
Long‐Term Prediction of Incident Hip Fracture Risk in Elderly White Women: Study of Osteoporotic Fractures
Authors: Taylor Brent C. , Schreiner Pamela J. , Stone Katie L. , Fink Howard A. , Cummings Steven R. , Nevitt Michael C. , Bowman Paula J. , Ensrud Kristine E.
Published: August 2004

Objectives: To identify independent risk factors for first hip fracture over 10 years of follow‐up.

Design: Prospective cohort study.

Setting: Four U.S. clinical centers.

Participants: A total of 6,787 women aged 66 and older in the Study of Osteoporotic Fractures.

Measurements: Total hip bone mineral density (BMD) using dual‐energy x‐ray absorptiometry and a comprehensive set of potential risk factors were collected. Incident hip fractures were identified prospectively and confirmed using radiographic report.

Results: Six hundred two women (8.9%) had a hip fracture during a mean ±standard deviation (SD) follow‐up of 10.1±3.2 years. Older age, previous self‐reported fracture after age 50, maternal history of hip fracture after age 50, greater height at age 25, impaired cognition, slower walking speed, nulliparity, type II diabetes mellitus, Parkinson's disease, and depth perception each independently predicted a 1.17‐ to 1.83‐fold increase in hip fracture risk, whereas each SD (0.13 g/cm2) decrease in hip BMD was independently associated with a 1.84‐fold increase in risk. Lower body mass index also was associated with an increased risk of hip fracture, although lower hip BMD largely explained this association.

Conclusion: Although hip BMD is strongly related to hip fracture risk in elderly white women, other clinical risk factors also are independent predictors of long‐term risk and provide additional insight into the prevention of fracture in high‐risk women. Clinicians should be alert to factors other than BMD that place older women at a high risk of hip fracture.
The Effectiveness of a Community‐Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial
Authors: Clemson Lindy , Cumming Robert G. , Kendig Hal , Swann Megan , Heard Robert , Taylor Kirsty
Published: August 2004

Objectives: To test whether Stepping On, a multifaceted community‐based program using a small‐group learning environment, is effective in reducing falls in at‐risk people living at home.

Design: A randomized trial with subjects followed for 14 months.

Setting: The interventions were conducted in community venues, with a follow‐up home visit.

Participants: Three hundred ten community residents aged 70 and older who had had a fall in the previous 12 months or were concerned about falling.

Intervention: The Stepping On program aims to improve fall self‐efficacy, encourage behavioral change, and reduce falls. Key aspects of the program are improving lower‐limb balance and strength, improving home and community environmental and behavioral safety, encouraging regular visual screening, making adaptations to low vision, and encouraging medication review. Two‐hour sessions were conducted weekly for 7 weeks, with a follow‐up occupational therapy home visit.

Measurements: The primary outcome measure was falls, ascertained using a monthly calendar mailed by each participant.

Results: The intervention group experienced a 31% reduction in falls (relative risk (RR)=0.69, 95% confidence interval (CI)=0.50–0.96; P=.025). This was a clinically meaningful result demonstrating that the Stepping On program was effective for community‐residing elderly people. Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17–0.59).

Conclusion: The results of this study renew attention to the idea that cognitive‐behavioral learning in a small‐group environment can reduce falls. Stepping On offers a successful fall‐prevention option.
Footwear Style and Risk of Falls in Older Adults
Authors: Koepsell Thomas D. , Wolf Marsha E. , Buchner David M. , Kukull Walter A. , LaCroix Andrea Z. , Tencer Allan F. , Frankenfeld Cara L. , Tautvydas Milda , Larson Eric B.
Published: August 2004

Objectives: To determine how the risk of a fall in an older adult varies in relation to style of footwear worn.

Design: Nested case‐control study.

Setting: Group Health Cooperative, a large health maintenance organization in Washington state.

Participants: A total of 1,371 adults aged 65 and older were monitored for falls over a 2‐year period; 327 qualifying fall cases were compared with 327 controls matched on age and sex.

Measurements: Standardized in‐person examinations before fall occurrence, interviews about fall risk factors after the fall occurred, and direct examination of footwear were conducted. Questions for controls referred to the last time they engaged in an activity broadly similar to what the case was doing at the time of the fall.

Results: Athletic and canvas shoes (sneakers) were the styles of footwear associated with lowest risk of a fall. Going barefoot or in stocking feet was associated with sharply increased risk, even after controlling for measures of health status (adjusted odds ratio=11.2, 95% confidence interval (CI)=2.4–51.8). Relative to athletic/canvas shoes, other footwear was associated with a 1.3‐fold increase in the risk of a fall (95% CI=0.9–1.9), varying somewhat by style.

Conclusion: Contrary to findings from gait‐laboratory studies, athletic shoes were associated with relatively low risk of a fall in older adults during everyday activities. Fall risk was markedly increased when participants were not wearing shoes.
Alcohol Screening Results in Elderly Male Veterans: Association with Health Status and Mortality
Authors: Bridevaux Isabelle Peytremann , Bradley Katharine A. , Bryson Chris L. , McDonell Mary B. , Fihn Stephan D.
Published: August 2004

Objectives: To evaluate the association between alcohol screening results and health status or mortality in elderly patients.

Design: Cross‐sectional and longitudinal cohort studies.

Setting: Primary care clinics at seven Veterans Affairs medical centers.

Participants: A total of 16,958 male patients aged 65 and older.

Measurements: Alcohol screening questionnaires were used to divide patients into four mutually exclusive groups: drinkers who screened negative or positive for problem drinking and nondrinkers (in the previous year) who screened negative or positive for problem drinking. A subset of patients (n=12,491) completed a measure of health status, the Medical Outcomes Study Short Form (SF‐36). All‐cause mortality was ascertained using Veterans Affairs data over a mean follow‐up of 2.8 years.

Results: Forty‐eight percent of participants reported drinking in the previous year. Half of the drinkers and nondrinkers screened positive for problem drinking. The SF‐36 item scores were consistently higher for drinkers than for nondrinkers and for patients who screened negative for problems than for those who screened positive. Similarly, survival was consistently better in drinkers than nondrinkers (mortality hazard ratio (HR)=0.74, 95% confidence interval (CI)=0.68–0.82) and in patients who screened negative for problem drinking than in those who screened positive (mortality HR=0.87, 95% CI=0.80–0.95). Nondrinkers who screened positive for problem drinking had the poorest health status and survival, whereas drinkers who screened negative for problem drinking had the best health status and survival.

Conclusion: Elderly patients who reported drinking alcohol and those who screened negative for problem drinking had consistently better health status and survival than those who did not drink and those who screened positive.
A Randomized, Double‐Blind, Placebo‐Controlled Clinical Trial of the Chinese Herbal Medicine “Ba Wei Di Huang Wan” in the Treatment of Dementia
Authors: Iwasaki Koh , Kobayashi Seiichi , Chimura Yuri , Taguchi Mayumi , Inoue Kazumi , Cho Shigehumi , Akiba Tetsuo , Arai Hiroyuki , Cyong Jong‐Chol , Sasaki Hidetada
Published: August 2004

Objectives: To evaluate whether a traditional Chinese herbal medicine, ba wei di huang wan (BDW), improves cognitive and physical functioning in dementia patients.

Design: An 8‐week randomized, double‐blind, placebo‐controlled trial.

Setting: Long‐term‐care facility in Japan.

Participants: Thirty‐three patients with mild to severe dementia (7 men and 26 women; mean age±standard deviation=84.4±7.8) were recruited and enrolled from May 2002 through September 2002.

Intervention: Participants were randomly assigned to the active drug (BDW) group (n=16) or the placebo group (n=17) and treated for 8 weeks.

Measurement: Cognitive function and activities of daily living (ADLs); palsatility index.

Results: After the trial, cognitive function as assessed using the Mini‐Mental State Examination (MMSE) significantly improved from 13.5±8.5 to 16.3±7.7 (P<.01, 95% confidence interval (CI)=−4.1 to −1.4) in the BDW group. The ADL score in the Barthel Index also significantly changed, from 61.8±34.6 to 78.9±21.1 (P<.01, 95% CI=−26.2 to −7.9). In contrast, MMSE and Barthel Index scores of the placebo group showed no significant change. Eight weeks after the end of the administration, MMSE and Barthel Index scores of the BDW group declined to the baseline level. The pulsatility index in the internal carotid artery as measured using Doppler sonography significantly decreased in the BDW group (2.5±1.7 to 1.9±0.5, P<.05) but not in the placebo group.

Conclusion: These results argue the benefits of BDW in the treatment of dementia.
Fall‐Risk Assessment and Management in Clinical Practice: Views from Healthcare Providers
Authors: Fortinsky Richard H. , Iannuzzi‐Sucich Michele , Baker Dorothy I. , Gottschalk Margaret , King Mary B. , Brown Cynthia J. , Tinetti Mary E.
Published: August 2004

Objectives: To determine the extent to which healthcare providers reportedly address evidence‐based fall risk factors in older patients after exposure to an educational intervention and to determine barriers reportedly encountered when these healthcare providers intervene with or refer older patients with identified fall‐risk factors.

Design: Cross‐sectional study using a structured interview.

Setting: Geographic area of Connecticut where the Connecticut Collaboration for Fall Prevention (CCFP) has been implemented.

Participants: Emergency department (ED) physicians, hospital‐based discharge planners or care coordinators (nurses or social workers), home health agency nurses, and office‐based primary care physicians (total n=33) after exposure to the CCFP implementation team.

Measurements: Self‐reported practices (direct intervention or referral) and barriers when addressing seven evidence‐based risk factors for falls: gait and transfer impairments, balance disturbances, multiple medications, postural hypotension, sensory and perceptive deficits, foot and footwear problems, and environmental hazards.

Results: Respondents were most likely to report directly intervening with or referring older patients for gait and transfer impairments (85%) and balance disturbances (82%) and least likely to do so when encountering foot or footwear problems (58%) and sensory or perceptive deficits (61%). ED physicians reported lowest rates of direct intervention or referral for foot or footwear problems (20%), home health agency nurses for sensory or perceptive deficits (50%), and office‐based primary care physicians for foot or footwear problems (50%). Patient compliance was the most commonly reported barrier to successful direct intervention across several risk factors, whereas inadequate availability of other healthcare providers and lack of Medicare reimbursement were the most commonly reported barriers to successful patient referrals.

Conclusion: After exposure to the CCFP implementation team, the majority of healthcare providers reported directly intervening or referring patients when addressing all risk factors, but results pinpointed specific healthcare provider groups with room for improvement in assessment and management of specific risk factors. Patient education appears to be a necessary adjunct to healthcare provider training, because patient compliance was a reported barrier to optimal intervention by healthcare providers.
A Comparison of Gait Characteristics Between Older Women with and Without Peripheral Neuropathy in Standard and Challenging Environments
Authors: Richardson James K. , Thies Sibylle B. , DeMott Trina K. , Ashton‐Miller James A.
Published: August 2004

Objectives: To compare gait patterns in older women with and without peripheral neuropathy (PN) in standard (smooth surface, normal lighting) and challenging environments (CE) (irregular surface, low lighting).

Design: Observational, controlled study of 24 subjects.

Setting: Biomechanical research laboratory.

Participants: Twenty‐four older women, 12 with PN and 12 without PN (mean age±standard deviation =67.1±7.9 and 70.2±4.3, respectively).

Measurements: Gait parameters and, in the 12 PN subjects, neuropathy severity.

Results: The CE was associated with increases in step width, step‐width variability, step‐width range, step width–to–step length ratio, step time and step‐time variability, and decreases in step length and speed. The PN subjects demonstrated a greater step width–to–step length ratio and step time and shorter step length and slower speed than the control subjects. In adapting to the CE, the PN subjects demonstrated greater increases in step width–to–step length ratio and step‐time variability and a greater decrease in step length than did the control subjects. In the standard environment, only one gait parameter correlated with PN severity, whereas in the CE, four gait parameters did so.

Conclusion: The subjects demonstrated a gait that was slower, less efficient, and more variable temporally and in the frontal plane in the CE. Control and PN subjects demonstrated similar variability in medial‐lateral step placement in the CE but at the cost of speed and efficiency for the PN subjects. Because the CE magnified gait differences between the two groups of subjects and caused gait changes in the PN subjects that correlated with PN severity, the CE may offer improved resolution for detecting gait abnormalities.
Blood Pressure Components and Cardiovascular Events in Older Adults: The Rotterdam Study
Authors: Mattace‐Raso Francesco U. S. , Van Der Cammen Tischa J. M. , Van Popele Nicole M. , Van Der Kuip Deirdre A. M. , Schalekamp Maarten A. D. H. , Hofman Albert , Breteler Monique M. B. , Witteman Jacqueline C. M.
Published: August 2004

Objectives: To compare the strength of the relative risks of systolic (SBP) diastolic blood pressure (DBP) and pulse pressure (PP) as predictors of myocardial infarction and stroke in older adults.

Design: Prospective cohort study.

Setting: The Rotterdam Study, a Dutch population‐based study.

Participants: A total of 4,234 subjects aged 55 and older with no previous myocardial infarction (MI) or stroke at baseline.

Measurements: Blood pressure levels at baseline, first MI and stroke, all‐cause mortality during follow‐up.

Results: During follow‐up, 205 subjects had an MI (average follow‐up period 7 years), 137 subjects had a stroke (average follow‐up period 6.1 years), and 748 subjects died. A 1–standard deviation difference in SBP, DBP, and PP was associated with relative risks of MI of 1.24 (95% confidence interval (CI)=1.06–1.46), 1.07 (0.92–1.25), and 1.25 (1.07–1.48), respectively. Corresponding relative risks for stroke were 1.59 (1.37–1.86), 1.27 (1.10–1.48), and 1.48 (1.27–1.72). For all‐cause mortality the corresponding relative risks and 95% CI were 1.21 (1.11–1.31), 1.06 (0.99–1.14), and 1.20 (1.10–1.31).

Conclusion: The results of this study suggest that, in a population of apparently healthy older adults, PP is not a better predictor of cardiovascular events and all‐cause mortality than SBP.
Comparison of Fracture, Cardiovascular Event, and Breast Cancer Rates at 3 Years in Postmenopausal Women with Osteoporosis
Authors: Silverman Stuart L. , Delmas Pierre D. , Kulkarni Pandurang M. , Stock John L. , Wong Mayme , Plouffe Leo
Published: August 2004

Objectives: To compare event rates for osteoporotic fractures, cardiovascular events, and breast cancer in postmenopausal women with osteoporosis.

Design: A prospective, observational study of the placebo group in the double‐blind, randomized Multiple Outcomes of Raloxifene Evaluation trial.

Setting: One hundred eighty clinical research centers in 25 countries.

Participants: Postmenopausal women (n=2,565, mean age=67) with osteoporosis were given calcium (500 mg/d) and vitamin D (400–600 IU/d) supplements.

Measurements: The occurrence of at least one new fracture, cardiovascular event, or breast cancer diagnosis at 3 years was identified and adjudicated.

Results: The occurrence of any fracture was the most common event in these women. In women without prevalent vertebral fractures (n=1,627), the event rates per 1,000 patient‐years were 45.4 for any fracture, 15.2 for vertebral fracture, 4.7 for clinical vertebral fracture, 0.9 for hip fracture, 8.3 for any cardiovascular event, and 5.2 for all breast cancer. In women with prevalent vertebral fractures (n=938), the event rates per 1,000 patient‐years were 117.4 for any new fracture, 77.1 for new vertebral fracture, 25.7 for clinical vertebral fracture, 5.8 for hip fracture, 15.1 for any cardiovascular event, and 2.6 for all breast cancer. The effect of prevalent fracture status on event rates was not dependent on whether women were older or younger than 65, but women aged 65 and older had a 3.6 times greater occurrence of cardiovascular events than younger women, irrespective of prevalent fracture status.

Conclusion: These data on the relative incidence of clinically significant skeletal and extra‐skeletal outcomes may be useful in choosing an agent for health maintenance for postmenopausal women with osteoporosis.
Validation of the Late‐Life Function and Disability Instrument
Authors: Sayers Stephen P. , Jette Alan M. , Haley Stephen M. , Heeren Tim C. , Guralnik Jack M. , Fielding Roger A.
Published: August 2004

Objectives: To assess the concurrent and predictive validity of the Late‐Life Function and Disability Instrument (LLFDI).

Design: Cross‐sectional.

Setting: University‐based human physiology laboratory.

Participants: One hundred one men and women aged 80.8±0.4.

Measurements: A short physical performance battery (SPPB) and a self‐paced 400‐m walk (400‐m W) were used as performance tests of lower extremity function. The LLFDI was used to assess self‐reported function and physical disability. Partial correlations adjusted for age and body mass index were used to determine the concurrent and predictive validity of the LLFDI. Statistical significance was accepted at P<.004 using a testwise correction.

Results: LLFDI Overall Function scores were moderately associated with the SPPB (r=0.65, P<.001), 400‐m W gait speed (r=0.69, P<.001), and measures of lower extremity function. Correlations of the two lower extremity subscores of the LLFDI (correlation coefficient (r)=0.63–0.73, P<.001) were greater than for the LLFDI upper extremity subscores (r=0.19–0.26, P>.004). Performance measures of function predicted disability limitations in the range of r=0.37–0.44 (P<.001) and disability frequency in the range of r=0.16–0.20 (P>.004).

Conclusion: These findings support the concurrent and predictive validity of the LLFDI. Results support the use of the LLFDI scales as a substitute for physical performance tests when self‐report is a preferred data‐collection format.
Clinical Global Impression of Change in Physical Frailty: Development of a Measure Based on Clinical Judgment
Authors: Studenski Stephanie , Hayes Risa P. , Leibowitz Ruth Q. , Bode Rita , Lavery Laurie , Walston Jeremy , Duncan Pamela , Perera Subashan
Published: August 2004

Objectives: To expand the ability to assess physical frailty by developing a Clinical Global Impression of Change in Physical Frailty (CGIC‐PF) instrument.

Design: Qualitative and quantitative instrument development.

Setting: Academic centers.

Participants: Six expert panel members, 46 clinicians, 24 patients, and 12 caregivers.

Measurements: Literature review and structured group processes with experts, clinicians, and consumers were used to generate an initial list of domains and indicators. Structured interviews with clinical experts in the area of frailty were used to establish relevance and feasibility of measurement of domains. Interrater reliability was assessed through a Web‐based study. Geriatricians pilot tested the feasibility of the baseline CGIC‐PF with 10 patients.

Results: The CGIC‐PF includes six intrinsic domains (mobility, balance, strength, endurance, nutrition, and neuromotor performance) and seven consequences domains (medical complexity, healthcare utilization, appearance, self‐perceived health, activities of daily living, emotional status, and social status). Each domain has two to four clinical indicators. Change is scored on a 7‐point scale from markedly worse to markedly improved. Average interrater reliability of the CGIC‐PF for the Web‐based cases was 0.97. Geriatricians completed a baseline CGIC‐PF on their own patients in 10 minutes or less.

Conclusion: The CGIC‐PF is a structured assessment of change in physical frailty with defined content and process. It has strong face validity, reliability, and feasibility for use in clinical research. It may be useful as one criterion of change and as an anchor for change in other measures.
Navigating Federalwide Assurance Requirements When Conducting Research in Community‐Based Care Settings
Authors: Cartwright Juliana C. , Hickman Susan E. , Bevan Leslie , Shupert Charlotte L.
Published: August 2004

There is an urgent need for research on quality of life and healthcare delivery for older adults living in community‐based care settings, yet implementing current federalwide assurance (FWA) requirements can be a challenge in these settings. This paper discusses FWA requirements for engagement in federally funded research as the requirements pertain to community‐based care settings. Factors that impede community facilities in achieving FWA approval include lack of organizational structure to provide oversight for the ethical conduct of research, administrator concerns regarding potential liability associated with obtaining the FWA, lack of resources to complete required paperwork, and lack of staff knowledge about human subjects protection and federal requirements for participating in research. Effects of the FWA process on investigators include the burden of extra time needed to support community‐based facilities to acquire a FWA and concerns that studies may be limited to only those community facilities with the resources to complete the FWA process. Investigator‐initiated strategies for conducting research in community‐based settings include considering study designs that are exempt from the FWA process and proactively assisting community‐based facilities to acquire FWA status. Investigators need to work with potential research sites and the office for human research protections to ensure that subjects are protected without shifting the burden of protection to ill‐prepared community administrators.
“He Did It on Purpose!” Family Correlates of Negative Attributions About an Adolescent Sibling
Authors: Matthews Lisa S. , Conger Rand D.
Published: August 2004

Scholars have suggested that family life may influence children's attributions about close relationships. Using a sample of 369 two‐parent families with 2 children (a target adolescent in the 8th grade and a sibling aged 10 to 18), we investigated whether the sibling's negative attributions regarding the target adolescent were associated with mother's and father's negative attributions regarding the target adolescent, or the gender constellation and birth order of the sibling pair. In addition, we used the self‐reported negative attributions of both siblings and adolescents to investigate whether attributions predicted one's own behavior, or whether the behavior of the partner predicted the perceiver's negative attributions. Structural equation models showed that mothers' and fathers' negative attributions regarding the target adolescent predicted concurrent negative attributions for girls, but not boys. In addition, siblings' negative attributions regarding each other predicted their negative and positive behavior toward the partner 2 years later. The positive behavior of the attribution target also predicted the perceiver's negative attributions, but its effect was weaker. Girl sibling pairs were less negative in their attributions than cross‐sex sibling pairs and boy sibling pairs. Finally, although younger siblings were less negative in their attributions than older siblings, this difference decreased over time. This study advances the knowledge of negative attributions in close relationships by identifying family correlates of an understudied, but important, close relationship.
The Sexual Debut of Girls in Early Adolescence: The Intersection of Race, Pubertal Timing, and Friendship Group Characteristics
Authors: Cavanagh Shannon E.
Published: August 2004

Scholars who have studied the effects of early pubertal timing on girls' sexual debut contend that this association may result from the company they keep. Although this basic biosocial model of adolescent behavior has been applied to various outcomes with diverse samples of adolescent girls, less work has contextualized this microlevel developmental phenomenon within the larger macrolevel structures of race and ethnicity. Using a sample of White, African American, and Latina girls (N=1,299) drawn from the National Longitudinal Study of Adolescent Health, this study conducted within‐group multivariate analyses and found important differences in the linkages that make up this biosocial model by race and ethnicity, with the linkages strongest for Whites, followed by Latina, and African American girls. These differences in association may reflect differences in the social construction of girlhood across race and ethnicity.
Sexual‐Minority and Heterosexual Youths' Peer Relationships: Experiences, Expectations, and Implications for Well‐Being
Authors: Diamond Lisa M. , Lucas Sarah
Published: August 2004

The current study compared the peer relationships and well‐being of 60 sexual‐minority (i.e., nonheterosexual) and 65 heterosexual youths between the ages of 15 and 23. Sexual‐minority youths had comparable self‐esteem, mastery, and perceived stress as did heterosexuals, but greater negative affect. Younger sexual‐minority male adolescents had smaller overall peer networks than did young male heterosexuals, whereas older male and female sexual minorities had larger numbers of extremely close friends within their networks than did heterosexuals. Younger sexual‐minority adolescents had lost or drifted away from more friends than did heterosexuals. Regardless of age, sexual‐minority youths reported disproportionately high worries about losing friends, low feelings of control in their romantic relationships, and fears of never finding the type of romantic relationship they wanted. Sexual‐minority youths that were “out” to more heterosexual peers had larger peer networks but more friendship loss and friendship worries. Youths' relationship experiences and concerns mediated sexual identity differences in negative affect.
Parenting Behaviors Among Mainland Puerto Rican Adolescent Mothers: The Role of Grandmother and Partner Involvement
Authors: Contreras Josefina M.
Published: August 2004

Relations between grandmother and partner involvement (coresidence, social support, child care) and Puerto Rican adolescent mothers' parenting behaviors were examined. Few associations between grandmother involvement and behavior emerged, and these were moderated by coresidence. In contrast, partner involvement showed a number of significant (positive) direct and moderated relations with behavior. For both providers, the direction of the relations between social support and behavior during teaching was the opposite depending on coresidence: Greater social support was related to the display of more positive behavior among coresiding mothers but to less competent behavior among non‐coresiding mothers. The relations between child care support and behavior differed across providers. For grandmothers, greater child care was related to less positive behavior during teaching among coresiding mothers but to more competent behavior among non‐coresiding mothers. For partners, greater child care was more strongly related to positive behavior during play among non‐coresiding than coresiding mothers. Results are discussed in light of Latino cultural values, developmental issues, and implications for intervention.
Father Absence and Youth Incarceration
Authors: Harper Cynthia C. , McLanahan Sara S.
Published: August 2004

This study measured the likelihood of youth incarceration among adolescent males from father‐absent households, using data from the National Longitudinal Survey of Youth (N=34,031 person‐years). At baseline, the adolescents ranged from 14 to 17 years, and the incarceration outcome measure spanned ages 15 to 30 years. This study tested whether risk factors concentrated in father‐absent households explained the apparent effects of father absence. Results from longitudinal event‐history analysis showed that although a sizable portion of the risk that appeared to be due to father absence could actually be attributed to other factors, such as teen motherhood, low parent education, racial inequalities, and poverty, adolescents in father‐absent households still faced elevated incarceration risks. The adolescents who faced the highest incarceration risks, however, were those in stepparent families, including father–stepmother families. Coresidential grandparents may help attenuate this risk, although remarriage and residential instability increased it. Social policies to support children should broaden beyond an emphasis on marriage to address the risks faced by adolescents living in stepfamilies as well.
Contesting the New York Community: From Liminality to the “New Normal” in the Wake of September 11
Authors: Abrams Courtney B. , Albright Karen , Panofsky Aaron
Published: August 2004

This article explores the processes involved in the construction and contestation of community in New York City following the disaster of September 11, 2001. By employing insights from the literatures on disaster and cultural meaning making, we examine how New Yorkers created and negotiated the meanings of the cultural, symbolic, and moral problems that followed the attacks. Though this postdisaster period has come to be heralded as one that witnessed a spontaneous and uniform rise in patriotism, helping behaviors, and memorial practices, we demonstrate that New Yorkers actively contested and negotiated these terrains. We argue that the tension inherent in this contestation was rooted in uncertainty about identity, interaction, and the boundaries of community in the wake of the attacks, and that its negotiation resulted in a structure of feeling that was fraught with lingering inconsistencies. This was ultimately taken for granted and incorporated into the cultural framework of the “new normal,” marking the collapse of the acute liminality of the New York community's postdisaster experience.
The Ecology of Racial Discrimination
Authors: Fischer Mary J. , Massey Douglas S.
Published: August 2004

In this article we build on prior studies that have used audit methods to document continued discrimination against African Americans in U.S. housing markets. Whereas prior work focused primarily on measuring racial disparities in housing access, here we seek to determine which personal, ecological, and agent factors raise or lower discrimination. Our data come from phone‐based audit studies of rental housing offered in the Philadelphia metropolitan market in the spring of 1999, the fall of 2000, and the spring of 2002. Male and female auditors called listings to inquire about the availability of units using white middle‐class English, black‐accented English, and Black English Vernacular. Results show that whites are more likely to be favored over black auditors of the same gender when the black auditor speaks Black English Vernacular compared with black‐accented English. Access was also lower in suburbs than the central city and it decreased as distance from a predominantly black neighborhood fell. Blacks experienced much lower access to units marketed by private landlords rather than professional agents. Blacks are more likely to gain access to areas that already have high concentrations of blacks or in areas that are not in danger of black encroachment (i.e., further away from black concentrations). These mechanisms serve to reinforce and replicate segregation.
Making Character Concrete: Empirical Strategies for Studying Place Distinction
Authors: Paulsen Krista E.
Published: August 2004

Actors orient themselves toward places based not only on major distinctions—coastal versus inland, large city versus small town—but based on a subtler and seemingly ineffable set of qualities, including meanings associated with place and patterns in local life. This article suggests that to understand how locality matters, we must not merely describe place in broad terms, but come to understand how material and symbolic aspects of place work together to direct activity on the ground. Place character is offered as a conceptual tool for understanding how qualities of place combine and influence local patterns in meaning and action. This article outlines strategies that can aid in uncovering just what constitutes a place's character by identifying understandings associated with specific locales and the social and material realities that provide the bases for these understandings. It also suggests approaches that reveal how character works to shape local action. Classic and contemporary studies are called on to elaborate the precedents and stakes of conducting this research and illustrate how the four research strategies presented here can be used. Concluding remarks suggest how researching place character might advance substantive understandings of situated social action.
Trends in Family Space/Time, Conflict, and Solidarity: Middletown 1924–1999
Authors: Bahr Howard M. , Mitchell Colter , Li Xiaomin , Walker Alison , Sucher Kristen
Published: August 2004

This article treats aspects of family life for which there are comparable data from students at three or more points over the 75‐year period 1924–1999, beginning with the 1924 Middletown high school surveys and drawing on the replications of 1977, 1989, and 1999. We reassess the Lynds' positioning of families in a trajectory of space and time that emphasized family decentering or dis‐integration, and that assumed that technological changes extending a family's circulation in time and space reduced family solidarity. Although national data suggest that some family decline has indeed occurred since the 1970s, among Middletown students last surveyed in 1999 there is quite remarkable stability in several of the Lynds' indicators. Trends in topics of parent‐child disagreement and students' perceptions of ideal parental traits suggest that family change does not necessarily mean family decline, and trends in emotional solidarity with parents, beginning in 1977, yield no evidence of decline. The Lynds assumed a linear, additive relation between family decline and nonfamily space/time utilization. We argue that their space/time indicators are problematic as correlates of family solidarity and suggest alternative measures. Students of 1999 reported spending less time with parents than did their predecessors, but their identification with and perceived closeness to parents was not lower than in earlier decades. At century's end, Middletown students seemed insulated from the widely reported national trend toward “rapidly loosening family bonds,” and continuity rather than family decline seemed the dominant trend. As parental time with children is significantly related to, but accounts for little of the variance in, children's emotional solidarity with parents, further work is needed on predictors of emotional solidarity in families.
Therapist Experience and “Style” as Factors in Co‐therapy
Authors: RICE DAVID G. , FEY WILLIAM F. , KEPECS JOSEPH G.
Published: August 2004

NOTE: SEVERAL PASSAGES HAVE BEEN TRANSPOSED IN THIS ARTICLE. IT HAS BEEN REPRINTED CORRECTLY IN VOL. 11, JUNE, 1972 AT PAGE 227

Self‐descriptions of general in‐therapy behavior, attitudes toward co‐therapy, and ratings of co‐therapy effectiveness were collected from 25 experienced (E) and 25 inexperienced (IE) therapists who treated a total of 48 married couples in co‐therapy. Major findings were: (a) six different therapeutic “styles” emerged via factor analysis of the therapists' self‐descriptions of in‐therapy behavior, (b) E and IE therapists as a group had different personal therapeutic styles and preferences as to the style desired in a co‐therapist, (c) subjectively rated effectiveness of co‐therapy correlated with the degree of comfort felt by the therapist in the relationship and the acceptance by the co‐therapist, and (d) there was evidence of a “point of diminishing returns” in satisfaction for therapists in general, which came with increasing experience in doing co‐therapy.
A Developmental Framework for the Analysis of Premarital Dyadic Formation
Authors: LEWIS ROBERT A.
Published: August 2004

A developmental framework for the analysis of premarital dyadic formation (PDF) is presented by the time‐order interrelating of six pair processes, i.e., the achieving of similarity perception, pair rapport, self‐disclosure, role‐taking, role‐fit, and dyadic crystallization. Empirical linkages between these pair processes are examined as underpinning for a conceptual framework from which developmental hypotheses may be generated and tested for the purpose of establishing construct validity for the PDF Framework.
Sculpting the Family
Authors: SIMON ROBERT M.
Published: August 2004

In family sculpting the members of a family create a physical representation of their relationships at one point in time by arranging their bodies in space. The techniques, rationale, and uses of this method no described.
Cross‐Cultural Family Therapy — A Malaysian Experience
Authors: KINZIE DAVID , SUSHAMA P. C. , LEE MARY
Published: August 2004

This case report illustrates the possibilities and difficulties of family therapy in a non‐Western culture. Malaysia is a truly multiracial society with diverse ethnic groups having different religions, languages, and cutural patterns of relationships. In addition, the nation as a whole, and each ethnic group in particular, is in the process of cultural change, which produces stress on the traditional family's style of relationships. The therapists working in this culture are often crossing religious, linguistic, and socioeconomic barriers, as well as encountering the cultural pressures placed upon families. We will formulate some general problems in cross‐cultural psychotherapy, discuss some aspects of this specific culture and family with a case report, and offer some suggestions for handling problems in family therapy under these circumstances.
The Self‐Report Questionnaire as a Change Agent In Family Therapy
Authors: MANN JAY , STARR SHELDON
Published: August 2004

Results of a recent study of the sexual behavior of a group of married couples indicated that the process of completing daily self‐reports of sexual behavior induced changes in the activities measured. On the strength of these results and other reports indicating that self‐monitoring may induce behavioral change, a procedure for using self‐report questionnaires as agents of change for families in therapy was devised and clinically tested. Application of the procedure to a variety of clinical problems is described.
Cognitive Style, Schizophrenia, and the Family: Methodological Implications of Contextual Effects
Authors: MOSHER LOREN R. , WILD CYNTHIA , VALCOV ALLEN , FEINSTEIN ANNA E.
Published: August 2004

The study of a single case of a family with one schizophrenic daughter is reported here. A variety of measures were used in the study and it was carried out in a number of different contexts. The study has substantive interest in regard to the inter‐connections of schizophrenia and of individual and familial patterns of cognition and perception. In addition it raises important methodological considerations stemming from the variability of the measures across differing contexts.
The Paraprofessional and Family Therapy
Authors: UMBARGER CARTER
Published: August 2004

The new career movement in the community mental health field will increasingly demand that training programs provide the paraprofessional with a clinical role that avoids the temporary and mostly erroneous advantages of being an “indigenous” worker. Clinical functions taught in training need to be related to the problems of the urban poor; it is this group that needs a concept of service that can combine management of reality with beneficial restructuring of psychological systems. The resulting role is that of the paraprofessional family therapist — a new career that offers service to the troubled family unit of the urban poor and vocational definition to the person who is so trained.