Early‐Onset Alcohol Use Among Native American Youth: Examining Female Caretaker Influence

This article investigates the influence of female caretaker substance use on early‐onset youth drinking among Native American families in the Northern Midwest. Data include 603 Native American families, with reports from female caretakers and youths aged 10 – 13 years. Two potential caretaker influences are taken into account: adolescent modeling of caretaker behaviors and the effects of caretaker substance abuse on parenting. Results of bivariate and path analysis provide support for the influence of caretaker substance use on adolescent drinking from both perspectives; these effects vary, however, depending on the type or degree of adult substance use, or both.     

Mental Disorders,Comorbidity, and Postrunaway Arrests Among Homeless and Runaway Adolescents

This study examined the associations between lifetime mental disorder, comorbidity, and self‐reported postrunaway arrests among 428 (187 males, 241 females) homeless and runaway youth. The analysis examined the pattern of arrests across five lifetime mental disorders (alcohol abuse, drug abuse, conduct disorder, major depressive episode, and posttraumatic stress disorder). The adolescents, ranging from 16 to 19 years old, were interviewed directly on the streets and in shelters in four Midwestern states using computer‐assisted personal interviewing. Extensive self‐reports of early life history, behaviors since running away from home, and diagnostic interviewing (UM‐CIDI and DISC‐R) were used to estimate possible disorders. There was a high level of postrunaway arrests reported by the youth; more than half were arrested at least once after the initial runaway, with the average of 4.4 times. Consistent with the hypotheses, there were differential associations between individual mental disorders and involvement with the criminal justice system. Only externalizing disorders such as substance abuse and conduct disorder were related to arrest. Street youth with multiple externalizing and internalizing disorders were more likely to be arrested than nondisordered youths.     

Disentangling the sources of variation in the survival of the European dipper

The population growth rate of the European dipper has been shown to decrease with winter temperature and population size. We examine here the demographic mechanism for this effect by analysing how these factors affect the survival rate. Using more than 20 years of capture-mark-recapture data (1974-1997) based on more than 4000 marked individuals, we perform analyses using open capture-mark-recapture models. This allowed us to estimate the annual apparent survival rates (probability of surviving and staying on the study site from one year to the next one) and the recapture probabilities. We partitioned the variance of the apparent survival rates into sampling variance and process variance using random effects models, and investigated which variables best accounted for temporal process variation. Adult males and females had similar apparent survival rates, with an average of 0.52 and a coefficient of variation of 40%. Chick apparent survival was lower, averaging 0.06 with a coefficient of variation of 42%. Eighty percent of the variance in apparent survival rates was explained by winter temperature and population size for adults and 48% by winter temperature for chicks. The process variance outweighed the sampling variance both for chick and adult survival rates, which explained that shrunk estimates obtained under random effects models were close to MLE estimates. A large proportion of the annual variation in the apparent survival rate of chicks appears to be explained by inter-year differences in dispersal rates.     

The effectiveness of couple therapy in Germany: a replication study

The utility of couple therapy has been investigated in a number of controlled clinical efficacy investigations, demonstrating the superiority of most forms of couple therapy relative to control groups. Despite its widespread use, the effectiveness of couple therapy in field settings is largely unknown. In 1997, Hahlweg and Klann published an effectiveness study of couple therapy as practiced in German and Austrian marital counseling agencies. The purpose of the current investigation was to replicate their earlier findings in a similar setting with identical measures. The findings demonstrate that the results are remarkably similar across the two studies and that couple therapy in these applied settings helps to alleviate relationship distress as well as individuals' depression.     

The experience of giving birth with epidural analgesia

Problem and backgroundThere is a lack of literature about what constitutes good midwifery care for women who have epidural analgesia during labour. It is known that an increasing number of women receive epidural analgesia for labour pain. We also know that while women rate the painkilling effect of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used.QuestionHow do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need?MethodsA field study and semi-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth.FindingsInitiation of epidural analgesia can have considerable implications for women's experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence.Another important finding refers to the labouring woman's relationship with the midwife, which represents an essential influencing factor on the woman’ experience of labour. Within this relationship, some rather unnoticed matters of communication and recognition appear to be of decisive significance.ConclusionAfter initiation of epidural analgesia the requirements of midwifery care seem to go beyond how women verbalise and define their own needs. The midwife should be attentive to the labouring woman's type of emotional reaction to epidural analgesia and her possible intricate worries.     

Investigation of age–treatment interaction in the SPACE trial using different statistical approaches

Selection of treatments to fit the specific needs for a certain patient is one major challenge in modern medicine. Personalized treatments rely on established patient–treatment interactions. In recent years, various statistical methods for the identification and estimation of interactions between relevant covariates and treatment were proposed. In this article, different available methods for detection and estimation of a covariate–treatment interaction for a time-to-event outcome, namely the standard Cox regression model assuming a linear interaction, the fractional polynomials approach for interaction, the modified outcome approach, the local partial-likelihood approach, and STEPP (Subpopulation Treatment Effect Pattern Plots) were applied to data from the SPACE trial, a randomized clinical trial comparing stent-protected angioplasty (CAS) to carotid endarterectomy (CEA) in patients with symptomatic stenosis, with the aim to analyse the interaction between age and treatment. Time from primary intervention to the first relevant event (any stroke or death) was considered as outcome parameter. The analyses suggest a qualitative interaction between patient age and treatment indicating a lower risk after treatment with CAS compared to CEA for younger patients, while for elderly patients a lower risk after CEA was observed. Differences in the statistical methods regarding the observed results, applicability, and interpretation are discussed.