Direct assessment of quality of care in a geriatric nursing home

Direct observation was used to examine multiple aspects of care provided in a proprietary nursing home. The samples were taken at random intervals, 7 days per week for 5 weeks, across several categories of environmental and resident conditions as well as staff and resident activity. Results showed a high degee of compliance with predefined standards (based on current federal regulations) for environmental and resident conditions. Overall distributions of resident and staff activity showed results similar to those found in previous studies, with residents spending most of their time engaged in nonsocial activity and staff spending the majority of their time engaged in nonresident work. When data were analyzed across areas of the facility, times of day, and weekdays versus weekends, some differences were noted. Weekend versus weekday comparisons showed higher resident:staff ratios on weekends and more resident inactivity, but no significant differences in environmental or resident conditions. In addition, more frequent resident care, resident interaction, and resident activity were observed in Medicare units than in non-Medicare units. Results are discussed in terms of federal requirements for monitoring the quality of care in nursing homes and the potential use of time sampling expressly for this purpose.     

PHYSICAL AND PSYCHIATRIC CORRELATES OF GENDER DISCRIMINATION

We tested the model that sexist discrimination, measured by the Schedule of Sexist Events (SSE), would account for additional variance in women's physical and psychiatric symptoms, above and beyond that accounted for by generic stressors. A series of hierarchical regression analyses, predicting symptoms on 10 different symptom outcome measures from generic stress and sexist stress (discrimination) were conducted, with the generic stressors entered on the first step and sexist discrimination on the second. Results revealed that sexist discrimination contributed significantly to the variance in women's symptoms, accounting for additional variance in those symptoms. Furthermore, sexist discrimination accounted for more of the variance than did generic stressors in premenstrual, depressive, obsessive-compulsive, somatic, and total psychiatric and physical symptoms. These findings varied with the age and ethnicity of the women and with the symptom measure used, but nonetheless suggest that sexist discrimination plays a significant role in women's most prevalent symptoms.     

Children’s acquisition of language: General linguistic competence or dimensions of style?

Previous studies have described children’s acquisition of language as reflecting either a referential or an expressive style. A multivariate approach, characterizing “referentiality” and “expressivity” as partially dissociable dimensions, is advantageous because it allows children to vary along one dimension as they vary along another, allowing children to have high or low degrees of both characteristics simultaneously. The present study applies multivariate techniques to an “exploratory” sample of 87 children, all of whom were 20 months old, and by subsequently validating the exploratory phase with 56 of the original children seen one month later. Using parental reports to assess children’s multiword productions, exploratory factor analyses revealed two correlated dimensions of language style which indeed reflected referential and expressive characteristics. Confirmatory factor analyses “confirmed” these factors in the test sample. This two-dimensional model of language acquisition was superior to a unidimensional, general linguistic competence model. There is also strong short-term stability for both dimensions across the one-month period.     

Dependence: A means or an impediment to growth?

Dependence is generally viewed negatively, and in therapeutic situations it is often considered to be 'unhealthy'. In object relations theory and attachment theory, however, it is acknowledged that dependent or care-seeking behaviour is activated even in 'healthy' adults in times of distress. This suggests that dependency is likely to be an issue for all professionals whose work involves a counselling element. In order to investigate views of dependency in the therapeutic relationship, an exploratory qualitative study was conducted with three focus groups. The resulting data indicate considerable concern relating to issues of dependency, and a need for more rigorous research into the management of client dependency.     

BOOK REVIEW

Book reviewed in this article: The Family Therapy of Drug Abuse and Addiction M. Duncan Stanton, Thomas C. Todd, and Associates New York: Guilford Press, 1982.     

Hemispheric specialization for the perception of speech sounds: The influence of intonation and structure

The present report investigates the effect of various cues to phrase structure upon the hemispherically lateralized processing of phonetic structure. Meaningless sequences were paired for dichotic presentation and were delivered under two different conditions termed structured and semistructured. The dichotic sequences in the two conditions contained the same nonsense syllable stems, English bound morphemes, and English function words. Also each of the sequences in both conditions were grammatically ordered in the sense that if the nonsense stems were replaced by English stems, a grammatical sentence would result. The conditions differed with respect to prosody, however: the structured sequences were characterized by the acoustic correlates of constituent structure; the semistructured sequences were delivered in a monotone. A significant right-ear superiority was observed in the structured condition, but not in the semistructured condition. These perceptual laterality differences are discussed in relation to cerebral dominance for language and in relation to speech processing generally.     

Conditioned fear-induced opiate analgesia on the Formalin test: Evidence for two aversive motivational systems

Fear, conditioned to apparatus cues associated with electric shock, was measured by recording freezing. Pain reactivity was simultaneously measured by recording the paw-licking and paw-lifting response to Formalin injected into a paw. Stimuli associated with shock produced freezing and inhibited the responses to Formalin; whereas various control stimuli did neither. These results indicate that one of the responses to fear is analgesia. The opiate antagonist naltrexone reversed this analgesia, suggesting that the analgesia has an opiate nature. The results were interpreted in terms of a two-aversive-motivational-systems model. One system, the pain system, is instigated by tissue-damaging stimuli and produces recuperative behavior that functions to promote healing. The other system, the fear system, is triggered by conditioned fear stimuli. It produces species-specific defensive reactions and also inhibits the pain system via analgesia.