bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic biliary drainage for severe acute cholangitis in biliary obstruction as a result of malignant and benign diseases
Authors: KUMAR RAKESH , SHARMA BARJESH C , SINGH JAGDEEP , SARIN SHIV K
Published: August 2004

Background and Aims:  Endoscopic biliary drainage is an established mode of biliary decompression in patients with acute cholangitis as a result of biliary obstruction secondary to stones and benign strictures. However, there are no reports on endoscopic management of severe acute cholangitis caused by malignant conditions. We prospectively compared the efficacy of the endoscopic drainage for severe acute cholangitis in biliary obstruction as a result of malignant and benign diseases.

Methods:  Forty‐three patients with severe acute cholangitis requiring urgent biliary drainage were included. Sixteen patients (mean age 58.2 ± 9.3 years; seven men, nine women) had biliary obstruction as a result of malignant diseases and 27 had benign biliary diseases (mean age 41.6 ± 14.3 years; nine men, 18 women). Indications for urgent drainage included any one of the following: temperature >38°C (n = 21), septic shock with systolic blood pressure <100 mmHg (n = 9), localized peritonism (n = 21), impaired consciousness (n = 6) and failure to improve within 72 h of conservative management (n = 13). After successful bile duct cannul°ation, patients received either a nasobiliary catheter (n = 38) or an in‐dwelling stent (n = 5) with or without sphincterotomy for biliary drainage. Outcome measures included complications and clinical response.

Results:  Endoscopic drainage was established successfully in all the patients in both the groups. Clinical improvement after biliary drainage occurred in 94% patients (15/16) in the malignant group compared with 96% patients (26/27) in the benign group (P = not significant [NS]). Fever subsided at a median of 2.2 days in the malignant group and at 1 day in the benign group (P = NS). Normalization of leukocyte count was seen at a median of 6 days (range 1–17) and 2 days (range 1–5) days in the malignant group and the the benign group, respectively (P = NS). There were no endoscopic retrograde cholangiopancreatography‐related complications. The mortality rate as a result of cholangitis was 4.6%, that is two of 43 patients (6.2% of the malignant group vs 3.7% of the benign group; P = NS).

Conclusions:  Endoscopic biliary drainage is equally effective in patients with severe acute cholangitis caused by either malignant or benign biliary diseases.
Survey on chronic pancreatitis in the Asia–Pacific region
Authors: GARG PRAMOD KUMAR , TANDON RAKESH KUMAR
Published: August 2004

Background and Aims:  A survey was conducted of chronic pancreatitis (CP) in different countries in the Asia–Pacific region. The main objective of the survey was to generate a database containing information regarding the prevalence, etiology, clinical presentation, diagnostic work‐up, and management of CP in the Asia–Pacific region.

Methods:  Data were collected from seven countries using a structured questionnaire. Expert participants were asked to respond to the questionnaire based on the data of patients with CP studied in their centers.

Results:  The prevalence of CP was found to be very high in southern India (114–200/100 000 population), in contrast to the low reported rate of 4.2/100 000 population in Japan. Alcohol was the most common etiological factor in Australia (95%) and Japan (54%) while idiopathic pancreatitis was the most common type in India (tropical pancreatitis) and China, accounting for approximately 70% of all cases of CP. Pain was the most common clinical feature. Diabetes and steatorrhea were uncommon. With regard to the diagnosis of CP, all the experts believed that a patient could be diagnosed as having CP in the presence of any one or more of the following: ductal changes on endoscopic retrograde cholangiopancreatography, a positive secretin test, pancreatic calcification, and endosonographic abnormalities suggestive of CP. Most experts suggested pancreatic enzymes and analgesics as initial medical therapy for pain relief in CP. Endotherapy was suggested as the therapy of choice if medical therapy failed. Surgery was offered only after the failure of endotherapy. Most experts agreed that research should focus on genetic abnormalities in CP and the role of endotherapy for pain relief.

Conclusion:  The survey brought out the prevalent types and presentation of CP, common management practices, and also the shortcomings in the existing knowledge of CP in the Asia–Pacific region. These findings might help focus attention on the research priorities for CP in this region.
Pancreatic enzyme supplement improves dysmotility in chronic pancreatitis patients
Authors: MIZUSHIMA TAKAAKI , OCHI KOJI , ICHIMURA MITSUKO , KIURA KATSUYUKI , HARADA HIDEO , KOIDE NORIO
Published: August 2004

Background and Aims:  Impaired gallbladder contraction and rapid gastric emptying in patients with chronic pancreatitis may be the result of depleted pancreatic exocrine function. The authors tested whether oral pancreatic enzymes can improve the dysmotility or not.

Methods:  Study subjects consisted of 15 patients with chronic pancreatitis and 18 healthy controls. The gastric emptying time and gallbladder contraction were studied. All patients were initially studied using a test meal without pancreatic enzymes, followed on separate days by a test meal with a single and a triple dose of pancreatic enzymes. Blood samples were taken before and 2 h after the test meal to determine the pancreatic polypeptide levels.

Results:  In patients with chronic pancreatitis, gallbladder contraction at 15 min after the meal was impaired. The gastric emptying time was faster and the ratio of pre‐ to postprandial pancreatic polypeptide levels was enhanced. A single dose and a triple dose of oral enzymes further improved the gastric emptying time and the pancreatic polypeptide ration, but did not improve the gallbladder contraction rate at 15 min.

Conclusions:  It was demonstrated that the oral pancreatic enzymes improved the gastric dysmotility, confirming the previous findings that suggested the depleted pancreatic enzyme output caused the dysmotility.

© 2004 Blackwell Publishing Asia Pty Ltd
Closed lesser sac lavage in the management of pancreatic necrosis
Authors: WIG JAI DEV , METTU SRINIVAS REDDY , JINDAL RAVUL , GUPTA RAJESH , YADAV THAKUR DEEN
Published: August 2004

Background and Aim:  Surgery for pancreatic necrosis complicating acute severe pancreatitis carries a high risk of morbidity and mortality. We evaluated the efficacy of necrosectomy and closed lesser sac lavage as a method of management of pancreatic necrosis.

Methods:  Fifty‐eight patients with pancreatic necrosis who underwent pancreatic necrosectomy consecutively in a tertiary care referral center were retrospectively analyzed. The technique of necrosectomy and postoperative lavage is described in detail. Details regarding the patient profile, disease severity, surgical details, postoperative morbidity, repeat interventions and the mortality are presented.

Results:  Of the 58 patients, irrigation was able to be started in 48. Lavage was able to be continued until disease resolution or death in all but 10 patients. Post‐operative locoregional complications were residual abscesses in 10, bleeding in eight, enteric fistulae in 12 and pancreatic fistulae in nine. Six patients needed postoperative percutaneous procedures, while 16 patients needed repeat surgery. Seventeen patients died (29%), all of whom had multiple organ failure involving more than two organs, while 11 developed sepsis.

Conclusion:  Pancreatic necrosectomy and postoperative closed lesser sac lavage is an effective method of managing these patients, with acceptable morbidity, re‐operation rates and mortality.
Effects of home‐based combined resistance training and walking on metabolic profiles in elderly Japanese
Authors: Tokudome Mizuho , Nagasaki Masaru , Shimaoka Kiyoshi , Sato Yuzo
Published: August 2004

Background:  To evaluate the effects of home‐based combined resistance training and walking on metabolic profiles in elderly Japanese subjects.

Methods:  Two hundred and forty‐four elderly Japanese participants were divided into two groups (184 training group and 60 controls). Each exercise training session consisted of one set of 10 repetitions of 11 different resistance exercises, and the training lasted 12 weeks. Fasting blood samples were obtained for measurements of serum levels of total cholesterol, high‐density lipoprotein cholesterol (HDL‐C), triglycerides, hemoglobin A1c, insulin and plasma glucose, before and after the training period. We estimated insulin resistance using the homeostasis model assessment. Five subjects further underwent a two‐step hyperinsulinemic‐euglycemic clamp to evaluate insulin action directly before and after the training.

Results:  Training resulted in a significant increase in HDL‐C (60 ± 1–62 ± 1 mg/dL, mean ± SE, P < 0.01) and a significant decrease in triglycerides (115 ± 5–106 ± 4 mg/dL, P < 0.05), while no significant changes were observed for total cholesterol, plasma glucose, insulin, homeostasis model assessment or hemoglobin A1c. Glucose infusion rates during the hyperinsulinemic‐euglycemic clamp increased by 30% (P < 0.05) at the 40 mU/m2 per min infusion rate, from 5.4 ± 0.9 to 7.0 ± 1.1 mg/kg per min and by 15% (P < 0.01) at the 400 mU/m2 per min infusion rate, from 9.4 ± 1.0 to 10.8 ± 1.2 mg/kg per min. In the control group, no significant changes were noted except for a significant decrease in HDL‐C.

Conclusions:  Our home‐based exercise program for elderly is safe and effective for improving metabolic profiles.
Long‐term prognosis and satisfaction after percutaneous endoscopic gastrostomy in a general hospital*
Authors: Onishi Joji , Masuda Yuichiro , Kuzuya Masafumi , Ichikawa Masaaki , Hashizume Makoto , Iguchi Akihisa
Published: August 2004

Background:  Percutaneous endoscopic gastrostomy (PEG) has been widely acknowledged as a safer method for enteral feeding; however, its long‐term impact on prognosis and quality of life in elderly patients is not sufficiently understood. There are issues still to be studied regarding the indications for PEG, due to the lack of convincing evidence that it reduces expected complications such as aspiration pneumonia or for improving the prognosis of patients with severe dementia.

Method:  In this study we investigated the survival rate after PEG and the families’ satisfaction in 78 inpatients who underwent PEG. We conducted the investigation by sending questionnaires to the families.

Results:  The results for the 69 cases (88%) in which the patient recovered showed that the 1‐year survival rate was 64.0%, and the 2‐year survival rate was 55.5%. Fifty‐three per cent of patients’ families indicated overall satisfaction regarding of PEG.

Conclusions:  The survival rates were relatively higher than those from previously reported studies. This may be attributed to variations in patients’ clinical, socio‐economic, or cultural backgrounds in therapeutic interventions. We recognized the importance of clarifying factors that would affect the living and functional prognosis and quality of life in elderly patients who underwent PEG. The indications for PEG are based on a comprehensive assessment of the relevant factors in individual cases, and by taking patients’ and families’ wishes into consideration.
Improvement of inappropriate prescribing and adverse drug withdrawal events after admission to long‐term care facilities
Authors: Mita Yumiko , Akishita Masahiro , Tanaka Katsuaki , Yamada Shizuru , Nakai Ryuhei , Tanaka Eigo , Nakamura Tetsuro , Toba Kenji
Published: August 2004

Background:  The objectives of this study were to determine whether medications, particularly inappropriate prescribing, would be reduced after admission to long‐term care facilities, and whether adverse drug withdrawal events (ADWEs) would occur in relation to discontinuation of medications.

Methods:  The study consists of a retrospective survey using medical chart review in five health service facilities for the elderly in Japan. All the patients who were admitted to the facilities between January 2001 and December 2002 (N = 627) were participants in the study. Medications taken on admission, at 1 month and 3 months after admission, and events (significant worsening of the disease status, accidents, new symptoms and signs, and other acute events) during a 3‐month period were recorded. Inappropriate prescribing was determined using Beers’ criteria with some modification. ADWEs were determined using the Naranjo causality algorithm.

Results:  On admission, the patients were taking 3.5 ± 2.5 (mean ± SD) drugs. One month later, the number of prescribed drugs was decreased by 17% (P < 0.01 vs on admission), but did not show an additional reduction 3 months later. Inappropriate prescribing was found in 10% of the patients taking drugs on admission, but the number of inappropriately prescribed medications was reduced by 33% after 1 month. Of 105 events recorded, only five (2% of the patients with drug reduction) were considered ADWEs; three cases of confusion, a case of depression, and a case of hyperglycemia, following discontinuation of psychotropic drugs, antidepressants and a sulfonylurea, respectively.

Conclusion:  Adverse drug withdrawal events were not frequent despite the significant reduction of medications after admission to long‐term care facilities. This might be because the rate of reduction was relatively high for inappropriately prescribed medications.
Strategy for treating elderly Japanese with hypercholesterolemia*
Authors: Horiuchi Hisanori , Matsuzawa Yuji , Mabuchi Hiroshi , Itakura Hiroshige , Sasaki Jun , Yokoyama Mitsuhiro , Ishikawa Yuichi , Yokoyama Shinji , Mori Seijiro , Ohrui Takashi , Akishita Masahiro , Hayashi Toshio , Yamane Kiminori , Egusa Genshi , Kita Toru
Published: August 2004

Background:  It has been widely accepted that control of serum cholesterol levels is effective for prevention of cardiovascular events. Recent data have suggested that this is also the case in the elderly.

Methods:  A research group (chaired by T. Kita) was organized as part of the Comprehensive Research on Aging and Health conducted by the Japanese Ministry for Health, Labour, and Welfare in 1999–2002 to determine the best strategy for control of cholesterol levels in elderly Japanese with hypercholesterolemia. In order to do this a review of the literature was conducted.

Conclusion:  The research group concluded: (i) Japanese patients aged 65–74 years with hypercholesterolemia should be treated by following the Guideline for Diagnosis and Treatment of Atherosclerotic Cardiovascular Diseases by the Japan Atherosclerosis Society (2002), as cholesterol‐lowering therapy would bring a similar, or even larger, preventive effect to the elderly, whose absolute risk of cardiovascular events is higher than that in the younger population; (ii) target cholesterol levels in elderly Japanese aged ≥ 75 years with hypercholesterolemia should be determined individually according to their physical activities. It is noted that the elderly are more susceptible to drug‐related adverse effects than the younger since renal and liver functions, required for metabolizing drugs, in the elderly are relatively weaker.
Assessment of effects of traditional herbal medicines on elderly patients with weakness using a self‐controlled trial
Authors: Kogure Toshiaki , Sato Nobuhiko , Tahara Eiichi , Sakai Shinya , Shimada Yutaka , Ochiai Hiroshi , Origasa Hideki , Terasawa Katsutoshi
Published: August 2004

Background:  The objectives of this study were to evaluate the effects of traditional herbal medicine on elderly patients with weakness, and to devise a suitable study design for assessing the clinical effectiveness of traditional herbal medicines.

Methods:  Twenty‐one elderly patients with weakness (mean age, 78.2 ± 7.5; male : female, 8 : 13) were studied using a self‐controlled design with a run‐in period. The observation term was 3 months, and quality of life (short form‐36 and profile of mood status) were adopted as evaluation endpoints. In addition, natural killing activity and surface antigens (CD19, CD3, CD4, CD16, CD56, CD158a, CD158b) on lymphocytes obtained from peripheral blood were analyzed to evaluate patients’ immune status.

Results:  EK‐41 (Hochu‐ekki‐to), EK‐48 (Juzen‐taiho‐to) and EK‐98 (Ogi‐kenchu‐to) were administered to 10, 10 and one patients, respectively. There were no dropouts due to side‐effects. Results of the short form‐36 were significantly improved after 3 months, with the patients in the EK‐48 group showing greater improvement than those in the EK‐41 group. Each component of the profile of mood status was improved by the treatment, and the improvement of V, D and F was especially significant. D and A‐H were considerably improved in the patients of the EK‐48 group. In contrast, the improvement of D and T‐A was most marked in the EK‐41 group. Some augmentation of NK activity was observed after 3 months, but the effect was not significant. Although neither the CD4/8 ratio nor the percentages of CD3+, CD19+ or CD16+ CD158a + cells was changed significantly, the percentage of CD56+, CD56+ CD16+ and CD16+ CD158b + cells were significantly increased.

Conclusion:  A preliminary clinical trial for elderly patients with weakness was carried out to assess the efficacy of traditional medicines, resulting in evidence of their clinical and immunomodulating effects, although this evidence had some limitations. In addition, we obtained some insights into the elements of designing studies suitable for assessing the clinical efficacy of traditional herbal medicines.
Unemployment Invariance
Authors: Karanassou Marika , Snower Dennis J.
Published: August 2004

This paper provides a critique of the ‘unemployment invariance hypothesis’, according to which the behavior of the labor market, by itself, ensures that the long-run unemployment rate is independent of the size of the capital stock, productivity and the labor force. In the context of an endogenous growth model, we show that the labor market alone need not contain all the equilibrating mechanisms to ensure unemployment invariance; in particular, other markets may perform part of the equilibrating process as well. By implication, policies that raise the growth path of capital or increase the effective working-age population may influence the long-run unemployment rate.
Testing for Seasonal Fractional Roots in German Real Output
Authors: Caporale Guglielmo M. , Gil-Alana Luis A.
Published: August 2004

This paper examines the seasonal structure of German real GNP per capita by using a version of Robinson’s (1994) tests which is suitable in the context of seasonality. This method has several advantages over alternative approaches when testing for seasonal unit roots. First, unlike standard tests, which are nested in AR alternatives, it is embedded in fractional alternatives. Second, it allows testing at the zero frequency and at each of the seasonal frequencies separately. Third, it makes it possible to test for different orders of integration at each of the frequencies simultaneously. The empirical analysis suggests that the real output series may have a unit root at the zero frequency, and fractional rather than unit roots at the seasonal ones. This is in contrast to the findings reported by Lutkepohl et al. (1999) in their study on German money demand, and shows the importance of modelling the seasonal features of the data in alternative ways.
Status Preference, Wealth and Dynamics in the Open Economy
Authors: Fisher Walter H.
Published: August 2004

The implications of status preference in a simple open economy model are investigated in this paper. The open economy is modeled as a continuum of identical representative agents who have preferences over consumption and status. In the paper status is identified as relative wealth, which takes the form of relative holdings international financial assets. A symmetric macroeconomic equilibrium is derived in which status is the source of transitional dynamics for domestic consumption and the current account balance. This result illustrates another way to combine transitional dynamics with interior equilibria in the small open economy Ramsey model with perfect capital mobility. We also show that status preference plays a critical role in influencing the open economy’s adjustment to government expenditure and world interest rate shocks.
Arab ethnic enterprises in colonial Singapore: Market entry and exit mechanisms 1819–1965
Authors: Mattar Yasser
Published: August 2004

Abstract:  Ethnic entrepreneurs often concentrate in specific economic activities. Arab entrepreneurs in Singapore from the time of their first recorded arrivals in 1819 until the 1850s were concentrated in the consumer goods industry. The exit of the Arabs from consumer goods provision saw them moving into the real estate industry in the 1880s, where they remained concentrated until the 1940s. By the 1970s, however, no visible concentration of Arab entrepreneurs could be discerned. This paper argues that the entry and exit of Arab ethnic entrepreneurs into and out of consumer retail and real estate investments may be better explained with reference to political‐economic conditions which facilitate movement than embedded personal relations that enact a chain‐link pattern of industrial mobility.
Global‐local initiatives in FDI: The experience of Shenzhen, China
Authors: Wang Mark Yaolin , Meng Xiaochen
Published: August 2004

Abstract:  In 2002, China surpassed the USA to become the world's largest foreign investment destination. Many Chinese cities, especially those along the coast, have become hot spots for Foreign Direct Investment (FDI). The urban development of these Chinese cities, as in most market societies, has increasingly depended upon their global connections. However, it is unclear to what degree the governments of these cities are able to influence the decisions of foreign investors. This paper uses Shenzhen city as a case study to examine how multi‐nationals’ spatial and sectoral patterns have been changed over time and to what degree the local government has been able to influence multinationals’ locational and sectoral selection. It is concluded that Shenzhen has managed to create a strategy to maximise its ability to benefit from global economic forces and to attract multinational manufacturers in the locality, and particularly in increasing its target sector of technology‐intensive industry. This case study demonstrates the importance of a strong city government in managing growth and reacting decisively to globalisation.
Tourism and transitional geographies: Mismatched expectations of tourism investment in Vietnam*
Authors: Lloyd Kate
Published: August 2004

Abstract: The Vietnamese state's interaction with international capital has been influenced by the Communist Party's strategy to develop a ‘socialist market economy’ which aims to maintain the leading role of the state and its one party dominance while implementing economic reforms. This is at odds with alternatives proposed by neo‐liberal institutions such as the IMF and World Bank who favour a progression towards a more fully‐fledged market economy coupled with political pluralism. As a result, foreign investors and the Vietnamese government have had a turbulent relationship over the past decade stemming in large part from differing perceptions of a market economy and what foreign investment should entail. This paper depicts the principal issues that lay behind the restrictive policies toward foreign tour operators through a case study of their management and regulation in Vietnam throughout the 1990s. It is argued that foreign tour operators and Vietnamese tourism authorities perceive the role of international capital in tour operations quite differently. Over‐regulation has provided little space for foreign tour businesses to operate in a manner that has met their expectations, while government policies have been intent on ensuring that profits remain in the country. This paper also illustrates how social networks undermine top‐down government policy directives and allow foreign tour businesses to continue operating, albeit in a complex and insecure environment.
Structured regionalism in the Asia‐Pacific: Slow but sure progress
Authors: Das Dilip K.
Published: August 2004

Abstract:  Notwithstanding the existence of considerable intra‐regional trade, the Asia‐Pacific region was slow to catch onto the concept and phenomenon of regionalism. Not many regional integration arrangements were created in the region and the ones that were created did not go far. Over the preceding three‐and‐a‐half decades, the high performing Asian economies adopted outward‐oriented strategies, promoting brisk trade expansion trade and foreign investment. Asia‐Pacific regionalism was essentially market‐led and uninstitutionalised. Regional production networks were the consequence of market‐led economic dynamics in the region. Large corporations, including transnationals, contributed to the growth of a pan‐Asian industrialisation process and trade expansion. This scenario underwent a transformation in the 1990s, particularly during the Asian crisis of 1997–98. Conscious economic and monetary co‐operation with institutional support increased considerably. Asia‐Pacific economies are more committed to regionalism – both economically and institutionally – now than ever before.
‘Second generation’ Tongan transnationalism: Hope for the future?*
Authors: Lee Helen
Published: August 2004

Abstract:  Tonga's economy is supported by remittances from Tongans overseas, but there are indications that the younger generations are unlikely to maintain this level of support. There appears to be a complacent attitude to remittances both within Tonga and in externally produced economic reports, yet if remittance levels drop significantly, the ramifications will be disastrous for Tonga. This paper looks at Tongan transnationalism in the context of the current situation in Tonga and the wider Pacific, arguing that it will be crucial, yet very difficult, to encourage the ‘second generation’ overseas to be involved in the process of nation building through transnational engagements. The major obstacles to young people's establishment of transnational ties are examined, and the Tongan situation is compared to U.S. research on second generation trans‐nationalism in other migrant groups. Finally, the ways in which transnational engagements could be encouraged are explored, particularly the importance of language learning and developing a sense of ‘belonging’ to the ‘homeland’.
Educate, consolidate, immigrate: Educational immigration in Auckland, New Zealand
Authors: Butcher Andrew P.
Published: August 2004

Abstract:  This paper considers the convergence of immigration/globalisation and education in New Zealand. The issues of immigrant students at Epsom Normal Primary School were raised nationally in 1995, and this incident serves as a useful departure point to consider some of the challenges involved in bridging the gap between immigration and education. Educational immigration is a notion used by Belich (2001) amongst others, to suggest that immigrants arrive in New Zealand in order to bypass full cost fees paid by international students. This notion, while useful, is challenged. Research undertaken in North Shore City as well as official immigration figures show the complexities of the issue: immigrant communities may be indirect recruiters of these students, but there are also an increasing number of international students becoming permanent residents. Either way, education providers face particular challenges with migrant students, not only in terms of English language abilities, but also in the lack of financial incentive migrant students give to an education provider relative to international students’ contributions. These micro issues are placed in perspective when returning to considering the transient nature of many young migrants exploring opportunities in a globalised world.
The Results of Family Therapy Revisited: The Nonbehavioral Methods
Authors: WELLS RICHARD A. , DEZEN ALAN E.
Published: August 2004

Studies from 1971 to 1976 reporting on the outcome of the nonbehavioral family therapies are analyzed and critically reviewed. Such research has increased in both quality and quantity since 1970 and, broadly speaking, has legitimized the status of family therapy as a viable mode of helping. Particularly potent effects were noted for family therapy as an alternative to psychiatric hospitalization, with psychosomatic problems in children and adolescents, and in certain applications with parent‐child and parent‐adolescent relationships. However, a number of studies comparing family therapy with no formal treatment or an alternative treatment found little difference in outcome. Problems in family therapy outcome research are discussed and some future directions suggested.
Technolatry, Methodolatry, and the Results of Family Therapy
Authors: GURMAN ALAN S. , KNISKERN DAVID P.
Published: August 2004

Wells and Dezen's revisited results of research on the outcomes of nonbehavioral family therapy are themselves revisited. While their conclusions are largely defensible in terms of conventional criteria for research design and for assessing change in psychotherapy, we question whether such standard criteria are sufficient for studying the outcomes of family therapy. Moreover, Wells and Dezen's preoccupation with therapeutic technology at the expense of relationship factors and of “objective” change measures at the expense of more inferential measures severely limits the clinical and conceptual meaningfulness of their review.
Ideologies, Idols (and Graven Images?): Rejoinder to Gurman and Kniskern
Authors: WELLS RICHARD A. , DEZEN ALAN ETHAN
Published: August 2004

Three major issues raised in Gurman and Kniskern's commentary are discussed. These are (a) the suitability of established research design criteria for studying the outcome of family therapy; (b) the impact of therapist relationship factors on therapy outcome; and (c) the place of concrete or objective change measures in psychotherapy outcome research. Areas of agreement and disagreement with Gurman and Kniskern's observations are identified.
Family Ties and Child Placement
Authors: COLÓN FERNANDO
Published: August 2004

The fundamental premise of this paper is the primacy of the child's experience of biological‐familial continuity in establishing his sense of self and personal significance. This paper examines the effects of current child placement practices on the child's ties to his biological, foster, and adoptive families. It explores alternative practices that would take into account biological‐familial continuity.Comment is invited.
Birth Parents Who Relinquished Babies for Adoption Revisited
Authors: PANNOR REUBEN , BARAN ANNETTE , SOROSKY ARTHUR D.
Published: August 2004

The fact that adoption records may be opened by court decree to enable adoptees to have access to identifying information about their birth parents makes it incumbent upon those concerned with adoption practices to study the impact of this on adoptees, adoptive parents, birth parents, and professional practice. This paper reports on research addressed to the attitudes and feelings of birth parents years after they relinquished babies for adoption.
Keith: A Case Study of Structural Family Therapy
Authors: HEARD DAVID B.
Published: August 2004

This is an edited case presentation of marital therapy of a couple whose child was originally presented as the problem. Two primary themes are emphasized throughout the case. The first is that therapy consists of stages involving critical transitional points that need to be appropriately timed. The second is the use of a task to bring about structural realignment within the family. Excerpts were chosen because they clearly represent the process of movement in the therapy, illustrating both the stages of therapy and the utilization of an assigned task by the therapist. Commentary on the case material is interspersed throughout transcriptions.
Family Interaction and Communication Deviance in Disturbed and Normal Families: A Review of Research
Authors: DOANE JERI A.
Published: August 2004

Recent family interaction studies are reviewed with an emphasis on looking for dimensions along which disturbed and normal families differ. Several areas of consistency in the literature were found, including: family coalition patterns, patterns of conflict, flexibility versus rigidity, family effectiveness and efficiency, and deviant styles of communication. It was concluded that several measures reliably discriminate disturbed from normal families and that one type of measure in particular is a reliable predictor of thought disorder in offspring. Implications for clinical practice and future research are discussed.
Confusions and Conclusions: A Response to Doane
Authors: JACOB THEODORE , GROUNDS LINDA
Published: August 2004

The purpose of this paper is to evaluate critically the logic and conclusions of Doane's article (14), and in so doing, to raise serious questions regarding her evaluation of the family interaction literature. In particular, we suggest that Doane's paper is characterized by (a) a confused and inaccurate presentation of previous reviews; (b) a vague and contradictory set of terms around which she attempts to recast previous findings; (c) an arbitrary and unsystematic selection of findings used to support suggestions regarding reliable group differences; (d) uncritical and erroneous interpretations of findings that ostensibly support suggested differences between groups; and (e) a superficial acceptance of recent family interaction data concerned with the relationship between communication deviance/clarity and psychopathology. We hope our detailed critique will stimulate other observers of family interaction research to contribute more accurate and significant perspectives to the field than those presented in Doane's review.
Questions of Strategy: Rejoinder to Jacob and Grounds
Authors: DOANE JERI A.
Published: August 2004

Perhaps the best way to respond to Jacob and Grounds' critique is to focus on the more important issues they raise and to clarify some of the apparent confusion. It seems there are several general classes of criticism that Jacob and Grounds have offered: arbitrariness in selection of studies, inconsistency in reporting findings, inaccuracies in the data reported, and an overly favorable conclusion with respect to the communication deviance literature. Each of these issues will be dealt with here, using as many specific illustrations and examples as space permits.
Difficulties in Family Therapy Evaluation I. A Comparison of Insight vs. Problem‐Solving Approaches II. Design Critique and Recommendations
Authors: SLIPP SAMUEL , KRESSEL KENNETH
Published: August 2004

In Part 1, an outcome study comparing two methods of family treatment, is reported. Families were randomly assigned to one of two forms of conjoint therapy: an Insight‐oriented treatment (N = 10) or a Problem‐Solving intervention (N = 10). The results on self‐report measures of family functioning indicate that the Problem‐Solving intervention produced more favorable changes after three months. Experienced therapists did better than inexperienced therapists in the Insight‐treatment condition but level of experience did not make a difference in the Problem‐Solving therapy. A group of eight families who dropped out of the Insight‐treatment group provided data on correlates of premature termination.

In Part II, the study is critically reviewed. The practical obstacles to implementing an experimental design in a clinic setting are considered. Special attention is given to issues involving the selection of treatment and control conditions: sampling and the measurement of outcome. Alternatives to experimental designs are considered.
Power Relationships in Families: A Social‐Exchange Perspective
Authors: BECKMAN‐BRINDLEY SHARON , TAVORMINA JOSEPH B.
Published: August 2004

Although researchers have investigated power relationships in families for twenty‐five years, conclusions about normative family power patterns have been inconsistent and contradictory. Comparisons across studies have been difficult owing to different definitions of the construct, multiple methodologies, and inconsistent goals. With such confusion, a new, more integrated theoretical approach to the power issue seems warranted, as is suggested by the present paper. The current individual focus on power as a personal attribute can be replaced by a more dynamic, reciprocal, interactive process. Instead of specific or stable power patterns, power interactions should be fluid and time‐ or situation‐ specific. No one member would dominate, since power involves a mutual relationship system that changes its content, though not its rules of operation, across decision‐making areas. Furthermore, family adjustment would relate to those rules and the family members' reactions to their particular exchange system but not to specific types of power structures. With these considerations, future research should analyze the process, not the content, of power operations in order to maximize the clinical and theoretical utility of its construct.
Social‐Exchange Theory: Cognitive Restructuring in Marital Therapy
Authors: STRAYHORN JOSEPH
Published: August 2004

Problems arise in marital relationships when any of the following conditions are not met: first, that the couple have correspondence of their beliefs, or rules, as to what behaviors constitute “value messages” or “devalue messages”; second, that they depend primarily upon nonpainful channels for sending and receiving value messages; and third, that each partner's required quota of value messages from the other be of a reasonable quantity, not inflated by unrealistic fear of abandonment or devaluation. Problems in any of these areas may present in a variety of seemingly disparate fashions. Each of these problems is amenable to cognitive restructuring strategies. Different demands are placed on the therapeutic alliance and the marital alliance by the elucidation of each of these three types of problems; proper timing of interventions is therefore necessary.
Charting as a Multipurpose Treatment Intervention for Family Therapy
Authors: KATKIN STEVEN
Published: August 2004

This paper discusses the behavior modification technique of charting as a double‐bind communication. Though the procedure was initially employed as a step in demonstrating operant conditioning (7) and later in diagnosis of the antecedents and consequences maintaining undesired behavior (8), it also proved one of the more powerful therapeutic interventions. Literature reviews on treatment programs for obesity (6) and behavioral approaches to marital therapy (2) support this contention. Its efficacy can be explained by integrating the viewpoints of behaviorist and family therapy approaches espoused by Haley (4) and Weakland et al. (9). Following are brief case reports in which charting resulted in quick and sometimes dramatic change.
Fixation and Regression in the Family Life Cycle
Authors: BARNHILL LAURENCE R. , LONGO DIANNE
Published: August 2004

In spite of the obvious fact that families differ significantly depending upon their current stage of the life cycle, most of the family therapy literature focuses on intervening in ongoing family interaction without specific attention to the dimension of family development. Family sociologists, on the other hand, while not dealing with modifying family functioning, have provided more detailed tools with which to understand variations in family functioning based on stages of family development. Our work with families in acute distress suggests the need to increase the specificity with which our assessments and interventions are tailored, by incorporating the family developmental view.

This paper explores the utility of the family developmental view using the concepts of fixation and regression in the family life cycle. These concepts were found to be relatively refined and quite pragmatic assessment devices that assist therapists in specifying developmental issues of the family. Case examples of actual families in crisis are presented in order to demonstrate the utility of these conceptual tools.
An Index for Measuring Agency Involvement in Family Therapy
Authors: COLEMAN SANDRA B. , STANTON M. DUNCAN
Published: August 2004

The Progress Index for Family Therapy Programs, an instrument for measuring the relative level of involvement in family therapy by treatment programs, is presented. It was developed as part of a national survey on the use of family therapy for treating drug abuse and includes data from 500 agencies, 76 of which were Community Mental Health Centers. The Index may be useful for assessing extent of family therapy involvement for differing agencies treating different populations.
Aged care staff perspectives on oral care for residents: Western Australia
Authors: Paley Glenys A. , Slack‐Smith Linda M. , O'Grady Martin J.
Published: August 2004

Objective:  To determine manager and staff perceptions of oral health and dental service issues for residents in aged care facilities in the Perth Metropolitan Area, Western Australia.

Design:  Focus groups and face‐to‐face semi‐structured interviews with aged care facility managers and staff.

Setting and subjects:  Personnel at 12 facilities (high‐level and low‐level care) located in the Perth Metropolitan Area participated in the study. Interviews were conducted with 14 facility managers. Focus groups and face‐to‐face interviews were conducted with 40 facility staff.

Results:  Managers and staff had similar views regarding most issues. While resident oral health was considered important, regular oral care programmes were limited or lacking. In general, high care facility residents did not have regular dental checkups, while those in low‐level care facilities usually visited their own dentist for checkups or treatment. Barriers to maintaining regular oral care included: resident non‐compliance; financial concerns; lack of co‐operation from family; mobility issues; and lack of interest from dental professionals. Suggested improvements to current services included regular on‐site visits, staff education and specialised dental professionals.

Conclusion:  Residents face many barriers to maintenance of adequate oral health care, particularly those who are functionally dependent and cognitively impaired. There is an urgent need for appropriate oral care programmes for aged care residents, which include dentists with aged care experience and continuing education for facility staff. Any major programmes should be evaluated carefully.
Development of oral home telecare programme for the home‐dwelling elderly: a pilot study
Authors: Tomuro Kaori
Published: August 2004

Objectives:  The aim of the pilot study was to develop and evaluate a telecare programme for home‐dwelling elderly to provide education on oral and general health care.

Design:  A field trial with a computer system linking a university with a structured network.

Subjects:  A group of home‐dwelling elderly males with a mean age of 73.3 years.

Methods:  Qualitative assessment following videophone interviews with clients and their families.

Results:  Clients and families were able to gain a better understanding and knowledge of oral health care particularly the skills required to perform new oral care procedures.

Conclusions:  Preventive oral homecare via videophone offers the potential for providing a long‐term structure for maintaining oral health particularly with limited social resources.
Ten‐year cross‐sectional and incidence study of coronal and root caries and some related factors in elderly Swedish individuals
Authors: Fure Solveig
Published: August 2004

Objective:  The 10‐year incidence of dental caries was related to some associated factors in a random sample of 65, 75 and 85‐year‐old inhabitants of Gothenburg.

Subjects:  Of the 208 persons examined at baseline, 102 (49%) participated in the follow‐up examination; 56, 37 and nine, respectively, in the different age groups. For the purpose of time‐trend comparisons, a new random sample of 98 individuals aged 55 years was examined.

Results:  Ninety‐five per cent of the participants had developed one or more carious lesions during the 10‐year period and the incidence of coronal and root caries increased with age. In the 65‐year‐olds, 9% of the root surfaces had decayed during the period, compared with 25% in the 85‐year‐olds. Secondary caries predominated over primary caries and prosthetic crowns accounted for 70% of the restored tooth surfaces. Twenty per cent of the individuals were daily smokers and 61% were taking drugs with hyposalivatory side‐effects. The mean saliva secretion rates were lower in the older groups compared with the ‘younger’ ones. The overall salivary counts of mutans streptococci and lactobacilli had increased during the period and the values were highest in the oldest age groups. Salivary levels of lactobacilli and mutans streptococci, number of teeth, daily numbers of cigarettes and drugs and oral hygiene were the best predictors of the incidence of caries.

Conclusion:  The findings indicate that there is an increased risk of dental caries with age owing to unfavourable caries‐related factors.
Application of short‐form oral health impact profile on elderly Japanese
Authors: Ikebe Kazunori , Watkins Catherine A. , Ettinger Ronald L. , Sajima Hidenori , Nokubi Takashi
Published: August 2004

Objectives:  The purpose of this study was to use the oral health impact profile (OHIP‐14) to evaluate the impact of oral disease on the quality of life of a group of independently‐living elderly persons in an urban area of Japan.

Subjects:  A total of 1244 participants of the Senior Citizen's College, who attended the lectures once a week. They were community‐dwelling, independently‐living people over 60 years of age.

Measurements:  Japanese version of the short‐form OHIP‐14.

Results:  Internal reliability for the 14 items overall was very high (Cronbach's α = 0.95). Report of ‘painful aching’ and ‘uncomfortable to eat’ were the two most highly scored items using the mean sum OHIP‐14 score. A multiple logistic regression analysis indicated that the sum OHIP‐14 score had significant associations with self‐assessment of general health, dental status, and a perceived need for dental treatment. However, age, gender, dissatisfaction with financial status or education level was not significantly associated with the sum OHIP‐14. Compared with that of other countries, the items were ranked similarly, whereas the perceived magnitudes of the problems were quite different from other population.

Conclusions:  The OHIP‐14 in Japanese had a high internal reliability, was significantly associated with dental status and comparable ranking for items when compared with studies from other countries.