Family and sociodemographic influences on patterns of leaving home in Postwar Britain

We identify child-level and parent-level characteristics associated with children’s patterns of leaving home. We use a multilevel discrete-time hazards model to examine the impact of family and demographic factors at both levels, and utilize the Alternating Conditional Expectation algorithm optimally to transform the dependent and independent variables. We find that measured variables at both the child and the parent level have important influences, as do period and cohort factors. However, unmeasured parent-level factors have an influence on the departure of children that is broadly similar in magnitude to measured factors.     

Child Anger Regulation, Parental Responses to Children's Anger Displays, and Early Child Antisocial Behavior

The display and regulation of child anger in family interaction was coded in a sample of 240 boys and girls at child age 6, and coded using the Specific Affect Coding System. Child antisocial behavior was longitudinally assessed, beginning in kindergarten. Pooled‐ and family‐level analyses were used to assess hazard rates for child anger. Parents’ ability to modulate their own emotions and negative behavior, and children's ability to down‐regulate anger were associated with increased latency for child anger. Hazard for child anger increased as parents’ insensitive and negative responses toward the child cumulated during family interaction. Macro‐level, non‐hazard analyses indicated that chronic levels of child antisocial behavior were associated with the frequency of parental negative behavior, but not with the frequency of child anger. Micro‐level hazard analyses indicated that children's ability to regulate anger was related to chronic levels of child covert but not overt antisocial behavior.     

The importance of preservation of the ethical principle of equipoise in the design of clinical trials: relative impact of the methodological quality domains on the treatment effect in randomized controlled trials

Previous research has identified methodological problems in the design and conduct of randomized trials that could, if left unaddressed, lead to biased results. In this report we discuss one such problem, inadequate control intervention, and argue that it can be by far the most important design characteristic of randomized trials in overestimating the effect of new treatments. Current guidelines for the design and reporting of randomized trials, such as the Consolidated Standards of Reporting Trials (CONSORT) statement, do not address the choice of the comparator intervention. We argue that an adequate control intervention can be selected if people designing a trial explicitly take into consideration the ethical principle of equipoise, also known as "the uncertainty principle."     

Using HIT to deliver integrated care for the frail elderly in the UK: current barriers and future challenges

In this paper we briefly describe the results of a 3 year project examining the use of Health Information Technologies (e.g., electronic patient record systems) to deliver integrated care. In particular, we focus on one group of patient (the frail elderly) and efforts to design an e-health supported healthcare pathway (the frail elderly pathway--FEP). The aim of FEP is to bring together clinicians and staff from health and social care and allow them to share patient information. Our findings show that progress in delivering a fully-supported and working FEP has been slow, not least because of the difficulties experienced by healthcare staff in using current IT systems. In addition, there are many strategic and technical issues which remain unresolved (e.g., systems interoperability).     

Target detection from a classical and a Bayesian viewpoint

Two approaches have been used for designing spatial surveys to detect a target. The classical approach controls the probability of missing a target that exists; a Bayesian approach controls the probability that a target exists given that none was seen. In both cases, information about the likely size of the target can reduce sampling requirements. In this paper, previous results are summarized and then used to assess the risk that Roman remains could be present at sites scheduled for development in Greater London.     

Solving the Recruitment Crisis in UK General Practice: Time to Consider Physician Assistants?

With large numbers of GPs due to retire by 2007, the recruitment and retention crisis in UK general practice is likely to get worse before it gets better. Urgent measures are now required. Policies such as offering doctors financial incentives to enter general practice or delay retirement, while increasing the number of medical school places, may, for a variety of reasons, be likely to enjoy only limited success. In this article, a more radical solution is proposed: the creation of an intermediate medical practitioner role, along the lines of the physician assistant in the USA. The establishment of such a role may go some way to resolving the workforce crisis that currently besets general practice and ensure that medical needs, especially in deprived areas, are adequately met. A number of specific occupational groups who may find the PA role attractive are identified. It is suggested that refugee doctors, unable to practise in the UK, may find PA training particularly attractive, especially if it could serve as a stepping-stone to GMC registration.