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PubMed1990

The emerging relationship between academic health centers and continuing care retirement communities.

A survey of the 96 member-institutions of the Association of Academic Health Centers was conducted by the authors during the 1988-89 academic year to determine the number and types of contractual ties with continuing-care retirement communities (CCRCs). Of the 88 academic health centers that responded, 24% had an existing relationship with a CCRC; 26% were in the process of developing such a relationship; 7% had considered but decided against such a relationship; and 43% had not considered developing such a relationship. The authors document a rapid increase in the number of such relationships in the latter half of the 1980s and suggest that this trend is comparable to the increase in formal relationships with nursing homes begun by academic health centers in the early 1980s. Issues raised by those institutions that responded are presented, levels of possible involvement with a CCRC are described, and the contractual agreement between the University of North Carolina School of Medicine's Program on Aging and a local CCRC is presented as an example of the benefits that can be gained from such a relationship.

Academic Medical Centers↗
PubMed1996

Organizational models of medical school relationships to the clinical enterprise.

The authors analyzed existing relationships between medical schools and clinical enterprises in order to develop models of these relationships. The conceptual framework for the models uses three variables to assess the nature of the relationships: (1) high academic control-high clinical enterprise control; (2) high academic influence-low academic influence; and (3) self-contained system-open system (i.e., the extent to which the resources needed for clinical education are provided by the relationship between the clinical enterprise and the medical school). The authors present four conceptual models of the relationship between the medical school and the clinical enterprise: (1) The "single ownership; owned integrated system" is characterized by a closed clinical delivery system owned or controlled by the academic institution. (2) The "general partner" organization emphasizes an open clinical environment in which the medical school forms alliances with clinical entities, and the school is a dominant partner. (3) The "limited partner" organization operates with an open clinical delivery system that the school relates to through affiliations and contractual relationships, and the school is a less dominant partner. (4) The "wholly owned, subsidiary" organization operates in a controlled clinical environment in which the medical school is a subsidiary of the larger integrated delivery system. Each model is presented in its pure organizational form, then augmented with descriptions of the different ways that the medical school and other components may relate to each other. Also, the advantages and disadvantages of each model for the medical school are discussed. The authors emphasize that no model is superior to the others; instead, the best choice for a medical school depends on the history, local circumstances, and leadership of the school and other organizations. The authors' intent is to assist the leaders of medical schools as they design strategies for the future relationships of their institutions.

Interinstitutional Relations↗
PubMed2005

Responsibly managing the medical school--teaching hospital power relationship.

The relationship between medical schools and their teaching hospitals involves a complex and variable mixture of monopoly and monopsony power, which has not been previously been ethically analyzed. As a consequence, there is currently no ethical framework to guide leaders of both institutions in the responsible management of this complex power relationship. The authors define these two forms of power and, using economic concepts, analyze the nature of such power in the medical school-teaching hospital relationship, emphasizing the potential for exploitation. Using concepts from both business ethics and medical ethics, the authors analyze the nature of transparency and co-fiduciary responsibility in this relationship. On the basis of both rational self-interest, drawn from business ethics, and co-fiduciary responsibility, drawn from medical ethics, they argue for the centrality of transparency in the medical school-teaching hospital relationship. Understanding the ethics of monopoly and monopsony power is essential for the responsible management of the complex relationship between medical schools and their teaching hospitals and can assist the leadership of academic health centers in carrying out one of their major responsibilities: to prevent the exploitation of monopoly power and monopsony power in this relationship.

Academic Medical Centers↗
PubMed1993

Role of parent-child relationships in mediating the effects of marital disruption.

OBJECTIVE: This study sought to explore the long-term effects of and relationships between parental divorce, interparental conflict, and parent-child relationships on interpersonal and generalized trust, empathy, dependency, and depressive affect among late adolescents. METHOD: Self-administered questionnaire data were collected from a sample of 288 college students (including 60 children of divorce). Participants were asked to rate current and past levels of interparental conflict, the current affective quality of their parent-child relationships, and present adjustment. RESULTS: Path analyses revealed that the effects of interparental conflict on psychological well-being were mediated by parent-child relationships. For women, however, parental divorce also was found to affect adjustment indirectly (via disrupted father-daughter relationships), although no such path emerged for men. CONCLUSIONS: The findings are part of a growing literature documenting the role of parent-child relationships in mediating the effects of marital disruption. In addition to efforts to resolve marital conflict, clinicians may want to focus on enhancing mother-child, father-child relationships as a way to modify the damaging effects of conflictual marital relations on children and adolescents.

Adolescent↗
PubMed2000

Effects of parent personality, upbringing, and marijuana use on the parent-child attachment relationship.

OBJECTIVE: To examine the predictors of the quality of the parent-child attachment relationship among a sample of 248 young adults with children. METHOD: In this longitudinal study, data were collected during early adulthood in 1992 and in 1996/1997 via a structured questionnaire. Using logistic regression and multiple regression analyses, the authors assessed the extent to which participants' personality attributes, substance use, and relationships with their mothers predicted the quality of the parent-child bond. RESULTS: Logistic regression models showed that participants with certain personality attributes (e.g., high sensitivity), less frequent marijuana use, or a close relationship with their mothers had a greater likelihood of having a close parent-child attachment relationship with their own children at a later time. Regression analysis also showed that the risk of earlier substance use on the parent-child relationship was offset by protective factors in the parents' personality domain. In addition, protective factors in the various parental domains synergistically interacted with a low frequency of marijuana use, relating to a closer parent-child attachment relationship. CONCLUSIONS: The findings suggest that certain parenting styles are transmitted across generations and interventions in the personality and drug use domains can help increase the likelihood that parents will form close attachment relationships with their own children.

Adolescent↗
PubMed2000

Close relationships and social competence of hospitalized and nonhospitalized adolescents.

This study was designed to examine the social relationships of adolescents with severe disorders. The study sample consisted of 33 adolescent inpatients in a psychiatric unit, as well as 33 nonhospitalized adolescents. Participants completed the Network of Relationship Inventory for an assessment of the quality of their relationships with mother, father, close friend, and other significant adults. In addition, friendship intimacy was assessed. Results showed nonhospitalized adolescents describing a close relationship with their parents, as well as with their close friends. Their relationships with their friends were mature. Hospitalized adolescents described a less close relationship with their parents, whereas they were close to and valued their relationships with their friends and other significant adults. Though both groups described similar levels of emotional closeness, hospitalized adolescents tended more to exert control or to evince a penchant for similarity to the other in their friendships. Results are discussed within the framework of adolescent social tasks.

Adolescent↗
PubMedDate not supplied

Relationship-centered care: achieving true value in healthcare.

Intuitively, most healthcare leaders and caregivers appreciate the significance of effective relationships and their probable connection with positive patient outcome and financial success. In light of the lack of empirical descriptions and support for these relationships, however, a reluctance is seen to ascribe significant value, energy, and financial resources to relationship building. We describe the national initiative sponsored by the Fetzer Institute to support the Relationship-Centered Care Network, describe a relationship model to gain a greater appreciation of the complexities of relationships, and share experiences of an organization that operates based on the principles of relationship-centered care.

Academies and Institutes↗
PubMed2004

Extracting and characterizing gene-drug relationships from the literature.

A fundamental task of pharmacogenetics is to collect and classify relationships between genes and drugs. Currently, this useful information has not been comprehensively aggregated in any database and remains scattered throughout the published literature. Although there are efforts to collect this information manually, they are limited by the size of the published literature on gene-drug relationships. Therefore, we investigated computational methods to extract and characterize pharmacogenetic relationships between genes and drugs from the literature. We first evaluated the effectiveness of the co-occurrence method in identifying related genes and drugs. We then used supervised machine learning algorithms to classify the relationships between genes and drugs from the Pharmacogenetics and Pharmacogenomics Knowledge Base (PharmGKB) into five categories that have been defined by active pharmacogenetic researchers as relevant to their work. The final co-occurrence algorithm was able to extract 78% of the related genes and drugs that were published in a review article from the literature. Our algorithm subsequently classified the relationships between genes and drugs from the PharmGKB into five categories with 74% accuracy. We have made the data available on a supplementary website at http://bionlp.stanford.edu/genedrug/ Gene-drug relationships can be accurately extracted from text and classified into categories. Although the relationships that we have identified do not capture the details and fine distinctions often made in the literature, these methods will help scientists to track the ever-growing literature and create information resources to support future discoveries.

Algorithms↗
PubMedDate not supplied

Manager-physician relationships: an organizational theory perspective.

Manager-physician relationships are a critical determinant of the success of health care organizations. As the health care industry is moving toward a situation characterized by higher scarcity of resources, fiercer competition, more corporitization, and strict cost-containment approaches, managers and physicians should, more than ever, work together under conjoint or shared authority. Thus, their relationship can be described as one of high rewards, but also of high risk because of the wide range of differences that exist between them: different socializations and trainings resulting in different worldviews, value orientation and expectations and different cultures. In brief, managers and physicians represent different "tribes," each with its language, values, culture, thought patterns, and rules of the game. This article's main objective is to determine the underlying factors in the manager-physician relationship and to suggest ways that make this relationship more effective. Four different organizational perspectives will be used. The occupational perspective will give insights on the internal characteristics of the occupational communities of managers and physicians. The theory of deprofessionalization of physicians will also be discussed. The structuring perspective will look at the manager-physician relationship as a structure in the organization and will determine the effects of contextual factors (size, task uncertainty, strategy, and environment) on this relationship and the resulting effect on performance and effectiveness of the organization. The culture and control perspective will help detect the cultural differences between managers and physicians and how these interact to affect control over the decision-making areas in the hospital. The power, conflict, and dialectics perspective will shed the light on the conflicting interests of managers and physicians and how these shape the "power game" in the organization. Consequently, a theoretical model of manager-physician relationships that encompasses all these perspectives is developed.

Cooperative Behavior↗
PubMedDate not supplied

Nurse-physician collaborative relationship on nurses' self-perceived job satisfaction in ambulatory care.

The dynamic restructuring of the healthcare environment from a primary acute care focus to an ambulatory care focus has prompted a migration of nurses to the ambulatory care setting. The predication of nursing job satisfaction is a complex process that has received little attention in the ambulatory care setting. The purpose of this study was to determine if a relationship existed between the nurse-physician relationship and nurses' self-perceived job satisfaction in the ambulatory care setting. While study findings demonstrated there was no significant relationship between the nurse-physician relationship and nurses' self-perceived job satisfaction in the ambulatory care setting, it did confirm that registered nurses working in the ambulatory setting have a moderate level of job satisfaction. The lack of correlation between the nurse-physician relationship and job satisfaction may have been attributed to limitations such as a limited sample size and the nurses having a relationship with a smaller number of physicians in the ambulatory care setting. Recommendations to further understanding of the nurse-physician relationship included further descriptive studies of nurses working in the ambulatory care setting and further studies on job satisfaction of nurses.

Adult↗
PubMedDate not supplied

Adolescent-parent relationships in the context of adolescent chronic pain conditions.

OBJECTIVE: This study explored adolescent-parent relationships in families of adolescents with chronic pain. METHODS: A retrospective review was conducted on 112 adolescents with chronic pain who presented for clinical evaluation at an outpatient pediatric multidisciplinary pain management clinic. Adolescents reported on pain severity and duration, functional disability, and psychological distress. Parents responded to a measure of adolescent-parent relationship distress. RESULTS: The findings show that as a group, parents of adolescents with chronic pain syndromes reported less adolescent-parent relationship distress compared to normative data. Adolescent-parent relationship distress was inversely correlated with pain severity. A multiple regression model containing indicators of global psychological distress, pain severity, and adolescent-parent relationship distress predicted levels of adolescents' functional disability. Pain severity and functional disability were more closely linked at the low end of Adolescent-Parent Relationship Domain scores. DISCUSSION: The findings suggest important directions for future research to advance our understanding of the role of adolescent-parent relationships in the pain-disability cycle.

Adolescent↗
PubMed2005

Alcohol and atherosclerotic vascular disease risk factors in French men: relationships are linear, J-shaped, and U-shaped.

BACKGROUND: Although it is well admitted that alcohol displays a U-shaped relationship with atherosclerotic vascular disease, individual relationships between alcohol and atherosclerosis risk factors may be different and have not been determined precisely for several of them. METHODS: A cross-sectional study within the SU.VI.MAX French cohort study was performed to assess the curve of potential relationships between alcohol and atherosclerosis risk factors in 2126 healthy men. Mean daily alcohol intake was derived from 37 alcoholic beverages in twelve 24-hr dietary recalls. Logistic models were adjusted for age. RESULTS: Apolipoprotein B (ApoB), fasting glucose, body mass index, waist-to-hip ratio, and waist circumference displayed a linear relationship with alcohol. The odds ratios and 95% confidence intervals associated with abnormal values of the markers for the highest quintile of alcohol intake were 1.45 (1.06-1.97) for ApoB, 1.98 (1.40-2.80) for fasting glucose, and 1.74 (1.30-2.34) for body mass index. An inverse J-shaped relationship was assumed for ApoA1 and ApoB/ApoA1 ratio, whereas a U-shaped relationship was observed for serum triglycerides and mixed hyperlipidemia. Only the highest quintile of alcohol was associated with hypertension, although the test for linearity was also significant. No association was observed for Lp(a) or homocysteine. Associations were unmodified by further adjustment for carbohydrates, fiber, lipids, tobacco, or exercise. CONCLUSIONS: The aggregate of the disparate alcohol risk factor relationships suggests probable net benefit at 15 to 25 g of alcohol/day.

Alcohol Drinking↗
PubMed2006

The relationship between active and neural measures in patients with nonspecific low back pain.

STUDY DESIGN: Cross-sectional study of 50 individuals with nonspecific low back pain (LBP). OBJECTIVE: To evaluate the relationship between active and neural measurements in individuals with nonspecific LBP. SUMMARY OF BACKGROUND DATA: The Panjabi model for spinal stability consists of 3 interacting subsystems. Specific musculoskeletal measurements can be identified within the active and neural systems. The relationships among measures within this model have not been identified. METHODS: A total of 50 individuals with nonspecific LBP were evaluated for measures of the active and neural stability systems, and analyzed using a canonical correlation analysis, which is used to measure the relationship between 2 multidimensional variables. RESULTS: There were 2 significant relationships identified. The first identified a relationship among fatigue, flexion relation, and the feedforward abdominal response (r = 0.764, P < 0.001). The second relationship was between the Sorenson endurance test and feedforward abdominal response (r = 0.697, P = 0.006). CONCLUSION: Identification of relationships between back pain measurements may allow discrimination between individuals with different histology and pain levels. This process may assist the specificity of treatment programs prescribed for patients with back pain.

Abdominal Muscles↗
PubMedDate not supplied

The development of close relationships in Japan and the United States: paths of symbiotic harmony and generative tension.

Findings from research on parent-child and adult mate relationships suggest that there are different paths of development in Japan and the United States. In Japan, the path is one of symbiotic harmony, as seen in the emphasis on union in infancy, others' expectations in childhood, the stability of relationships with parents and peers in adolescence, and assurance about the mate relationship in adulthood. In the United States, the path is one of generative tension, as seen in the tug between separation and reunion in infancy, the emphasis on personal preferences in childhood, the transfer of closeness from parents to peers in adolescence, and the emphasis on trust-a faith and hope in new relationships-in adulthood. The notion that there are different paths of development challenges Western investigators' presumption that certain processes-separation-individuation, use of the relational partner as a secure base for exploration, and conflict between partners-are central in all relationships. The notion of different paths also challenges the assumption of many cross-cultural investigators that relationships in the United States are less valued or weaker than those in Japan; this article highlights cultural differences in the meaning and dynamics, as opposed to the importance and strength, of relationships. The model suggests a need to investigate the processes underlying, and the adaptive consequences of, these two alternative paths.

Adolescent↗
PubMed1989

A social relations analysis of toddler peer relationships.

We examined whether young children form different relationships with specific peers. Using the social relations model, effects of individuals as either actors or partners were distinguished from effects of relationships. Relationship effects are inferred when behavior within a dyad cannot be predicted from behavior that both partners give and receive in other social contexts. 32 20- or 30-month-old children were each paired with 2 partners (same age and gender) and observed for 18 40-min play sessions. The social relations analysis indicated that children differed consistently in their initiation of interaction (actor effects) and in the conflict contributions they elicited from their peers (partner effects). Relationship effects were found in games and contingent interaction, and were generally reciprocal. Relationship effects emerged gradually; in contrast, neither actor nor partner effects increased over time. Results were discussed in the context of definitions of relationships and peer relationships of young children.

Child, Preschool↗
PubMed1992

Children's relationships with caregivers: mothers and child care teachers.

Infant, toddler, and preschool children's relationships with mothers and teachers were examined in this study. 110 children were observed with their mothers during child care arrivals and reunions. 403 children were observed with their teachers in child care. 3 categories of relationships were derived from these observations. Children in the secure relationship category experienced more teacher involvement than children in the avoidant or ambivalent relationship categories. Children in the ambivalent relationship categories experienced more teacher involvement than children in avoidant relationship categories. A subsample (n = 23) of children were seen with their mothers both during child care arrivals and reunions and in the Strange Situation. Relationship classifications were similar.

Caregivers↗
PubMed2004

The longitudinal and concurrent role of neuroticism for partner relationships.

Neurotic characteristics of spouses have often been associated with dissatisfaction with the partner relationship. This article addresses the question whether the link between dissatisfaction with the relationship and neuroticism appears during the partner relationship, or whether it is present before the person enters the relationship. Utilizing data from a Swedish longitudinal project, satisfaction with the partner relationship was linked with neuroticism both in adolescence and in adulthood. Adolescent neuroticism was measured at age 15 with the High School Personality Questionnaire (HSPQ), and adult neuroticism was measured at age 37 with the Eysenck Personality Questionnaire (EPQ-I). Results showed that a lower degree of satisfaction in partner relationships in mid-life was linked with higher concurrent neuroticism scores. Opposing most of the previous studies, this association appeared for both men and women. Higher neuroticism in adolescence was, however, not significantly associated with satisfaction in partner relationships in mid-life.

Adult↗
PubMed1994

Children's perceptions of relationships with siblings, friends, and mothers: compensatory processes and links with adjustment.

Links between children's psychological adjustment and individual differences in their perceptions of relationships with siblings, mothers, and friends were studied in a sample of 85 second-graders. Results indicated that characteristics of these relationships were significantly correlated with children's loneliness, depressive mood, self-esteem, and behavioral conduct. There were some links among children's perceptions of their relationships with siblings, friends, and mothers. A compensatory model of associations among adjustment and warmth in children's relationships with friends and mothers was supported. Children who reported that their relationships with either mothers, friends, or mothers and friends were characterized by high levels of warmth had significantly better adjustment outcomes than children who reported low levels of warmth in relationships with both friends and mothers. The importance of the network of children's relationships for their mental health is discussed.

Adaptation, Psychological↗