Risk Estimation and Value-of-Information Analysis for Three Proposed Genetic Screening Programs for Chronic Beryllium Disease Prevention

Genetic differences (polymorphisms) among members of a population are thought to influence susceptibility to various environmental exposures. In practice, however, this information is rarely incorporated into quantitative risk assessment and risk management. We describe an analytic framework for predicting the risk reduction and value-of-information (VOI) resulting from specific risk management applications of genetic biomarkers, and we apply the framework to the example of occupational chronic beryllium disease (CBD), an immune-mediated pulmonary granulomatous disease. One described Human Leukocyte Antigen gene variant, HLA-DP beta 1*0201, contains a substitution of glutamate for lysine at position 69 that appears to have high sensitivity (approximately 94%) but low specificity (approximately 70%) with respect to CBD among individuals occupationally exposed to respirable beryllium. The expected postintervention CBD prevalence rates for using the genetic variant (1) as a required job placement screen, (2) as a medical screen for semiannual in place of annual lymphocyte proliferation testing, or (3) as a voluntary job placement screen are 0.08%, 0.8%, and 0.6%, respectively, in a hypothetical cohort with 1% baseline CBD prevalence. VOI analysis is used to examine the reduction in total social cost, calculated as the net value of disease reduction and financial expenditures, expected for proposed CBD intervention programs based on the genetic susceptibility test. For the example cohort, the expected net VOI per beryllium worker for genetically based testing and intervention is $13,000, $1,800, and $5,100, respectively, based on a health valuation of $1.45 million per CBD case avoided. VOI results for alternative CBD evaluations are also presented. Despite large parameter uncertainty, probabilistic analysis predicts generally positive utility for each of the three evaluated programs when avoidance of a CBD case is valued at $1 million or higher. Although the utility of a proposed risk management program may be evaluated solely in terms of risk reduction and financial costs, decisions about genetic testing and program implementation must also consider serious social, legal, and ethical factors.     

The journey from pain to power: A meta-ethnography on women’s experiences of vaginal birth after caesarean

Background

Vaginal birth after caesarean can be a safe and satisfying option for many women who have had a previous caesarean, yet rates of vaginal birth after caesarean remain low in the majority of countries. Exploring women’s experiences of vaginal birth after caesarean can improve health practitioners’ understanding of the factors that facilitate or hinder women in the journey to have a vaginal birth after caesarean.

Physical and mental health changes in aging foster parents: Do child behavioural problems hasten declines?

This study examined foster parent physical and mental health over time. It was hypothesized that increased severity and frequency of child behavioural problems, whether externalizing or internalizing, would be associated with poorer health over time, especially for foster parents ≥60 years of age. Data from the baseline and Wave 2 interview of the 2010 National Survey of Child and Adolescent Well‐Being were used. The final analytic sample included kin and nonkin foster parents who had custody of a foster child for both waves of data collection (n = 962). Ordinary Least Squares regression models with lagged dependent variables showed that foster parents ≥60 had deteriorating physical health over time, but caregiver age alone had no association with worsening mental health. However, parents ≥60 caring for children with externalizing behavioural problems had significantly improved physical health. Mental health of parents ≥60 significantly diminished if child externalizing or internalizing problems worsened. Findings indicate that for aging foster parents, externalizing child behaviours may stimulate physical activity and improved physical health, yet any type of child behavioural problem can deteriorate mental health functioning.     

A Shared Presentation: Two Disabled Women on Video

In this paper we share our collaborative experience of making a video in which disabled women present their lives as they wish to portray them. We undertook what we hope will be perceived as emancipatory research, in which disabled and non-disabled women work together to create audio-visual teaching materials. We include a preliminary discussion about the representation of disability on British television broadcasts between October 1991 and March 1992. We look at negative imagery, charity fund raising, and positive images. The paper uses comments by disabled broadcasters and disabled academics, and reflects on their work.     

Fertility desires and fertility: Hers,his, and theirs

The relationship between desired and achieved fertility may be misspecified by excluding husbands' fertility desires or by confounding effects of shared desires with the resolution of conflicting desires. Using couple data from the classic Princeton Fertility Surveys, we find relatively large husband effects on fertility outcomes as well as unique effects of spousal disagreement. Wives and husbands were equally likely to achieve fertility desires, and disagreeing couples experienced fertility rates midway between couples who wanted the same smaller or larger number of children. These conditions do not hold, however, when we include willingness to delay births for economic mobility as part of the measure of fertility desires. Among couples who both wanted a third child, only husbands' willingness to delay births had significant negative effects on birth rates.     

Assimilation versus multiculturalism: The views of urban Americans

Parents of children in public schools in a large American urban center, representing a number of different ethnic groups, were interviewed about their personal views and feelings toward cultural and racial diversity in America today. Three main issues were addressed: respondents' attitudes toward the maintenance of heritage cultures versus assimilation; their attitudes toward bilingualism; and their attitudes toward other groups in the community. The analyses revealed important differences in attitudes between ethnic minority groups and established white and black groups. Nonetheless, strong support was shown for the retention of heritage cultures, even among middle-class white and working-class black Americans. The working-class white American sample was distinctive in its rejection of multiculturalism and in its negative attitudes toward other ethnic and racial groups. All groups supported the idea of bilingualism for their children, and certain groups thought that public schools had an important role to play in its promotion. Overall, the results delineate a series of factors that affect intragroup and intergroup harmony and the processes of adjustment that transpire within a social system when it has to cope with ethnic and racial diversity.     

Becker's Side-Bet Theory of Commitment Revisited: Is It Time for a Moratorium or a Resurrection?

The results of Cohen and Lowenberg's 1990meta-analysis of 50 studies that empirically testBecker's (1960) side-bet model provide little empiricalsupport for his theory of commitment. They conclude that severe limitations of past research, both interms of measuring commitment and the strategies used totest the side-bet model, may be responsible for the lackof empirical support. Alternatively, they submit that if these methodological problems are notat fault, we should consider abandoning the side-bettheory. Three limitations of past side-bet research areaddressed in this study. The results of this study suggest that it is time to resurrect Becker'sside-bet theory of commitment. In doing so, we shouldsubject his theory to tests that employ more valid anddirect measures of the side-bet variables, that use measures of continuance commitment ratherthan affective commitment, and that apply to bothorganizational and occupational commitment.     

Decision-making style: Impact on satisfaction of the commuter couples' lifestyle

The entry of many women into the labor force in recent years has precipitated some changes for families. Commuter marriage is an attempt by some families to integrate work and family life. This article examines the decision-making style that 39 commuter couples use to make a decision if they should commute. The results indicate a more highly planned and systematically structured decision style relates to increased satisfaction with one's decision. Specific family and couple commuter style variables are discussed in relation to desirableness of lifestyle and coping strategies for commuter couples.Special acknowledgment is extended to Jane W. Spruill for her assistance with data collection and computer analysis. Support for computer analysis is acknowledged to the University of Maryland Computer Center. This research was supported in part by a Graduate Research Board Grant and a Divisional Small Grant Award, The University of Maryland, College Park, MD. This article benefited greatly from the suggestions of Charles Hennon and two anonymous reviewers.Her research interests include family policy issues, and work and families. She received her Ph.D. from The Pennsylvania State University.     

Deregulation and labor earnings

Cross-sectional data drawn from the March CPS from 1968 to 1988 and the May CPS from 1973 to 1988 are used to estimate the impact of deregulation on labor earnings in trucking, telephones, bus transportation, airlines, and railroads. Both average differentials and union-nonunion differentials are computed. Contrary to popular belief, deregulation does not reduce earnings in many of these industries. Implications for theories of regulatory impact are discussed.