Statistics for weighing benefits and harms in a proposed genetic substudy of a randomized cancer prevention trial

Summary.  When evaluating potential interventions for cancer prevention, it is necessary to compare benefits and harms. With new study designs, new statistical approaches may be needed to facilitate this comparison. A case in point arose in a proposed genetic substudy of a randomized trial of tamoxifen versus placebo in asymptomatic women who were at high risk for breast cancer. Although the randomized trial showed that tamoxifen substantially reduced the risk of breast cancer, the harms from tamoxifen were serious and some were life threaten-ing. In hopes of finding a subset of women with inherited risk genes who derive greater bene-fits from tamoxifen, we proposed a nested case–control study to test some trial subjects for various genes and new statistical methods to extrapolate benefits and harms to the general population. An important design question is whether or not the study should target common low penetrance genes. Our calculations show that useful results are only likely with rare high penetrance genes.     

The socialogy of football: a research agenda for the 1990s

The paper emphasizes the need for an alternative sociology of football that goes beyond the issue of football hooliganism, which has dominated work in the field. In the light of the Taylor Report and the agenda of modernization of football in the 1990s, research into the football crowd as a whole is required. A positive view of the state of English football in 1990 is presented as a corrective to the negative image of the 1980s. The debate is set in the context of my previous work on the politics of football both in Britain and the new Europe – West and East. In the final section, several topics are placed on the research agenda for the sociology of football in the 1990s. These are the modernization of facilities, the study of fanzines, comparative research and a social demography of the football crowd.     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.     

Are some disabilities more equal than others? Conceptualising fluctuating or recurring impairments within contemporary legislation and practice

In recent years, the concept of fluctuating or recurring impairments has grown both in the public consciousness as well as in frequency of note within policy documentation and legislation. However, contention still surrounds the perceived legitimacy of such impairments, including chronic fatigue syndrome/myalgic encephalomyelitis, epilepsy and diabetes, which have the potential to vary in intensity over time, versus more ‘traditional’ and accepted forms of disability. By drawing on current conceptual discussion and research activities in Canada around what have been termed episodic disabilities, as well as legislative developments in the United Kingdom, this paper will provide an overview of how fluctuating or recurring impairments have to date been conceptualised, contested, and the central issue of competing definitions within this context     

Mother and Grandmother Parenting in Low‐Income Three‐Generation Rural Households

This study draws data from the Family Life Project to examine parenting behaviors observed for 105 mothers and grandmothers raising an infant in rural low‐income multigenerational households. Multilevel models are used to examine the relationships between maternal age and psychological distress and parenting of the infant by both generations. The findings indicate that young maternal age is a risk factor for less sensitive parenting in the presence of other risks, including psychological distress. Further, young maternal age is associated with negative parenting behaviors by grandmothers only. Grandmothers and mothers displayed similar levels of negative intrusive parenting, but different factors were linked to the observed parenting of each generation. These findings contribute to understanding the benefits and risks of three‐generation households.     

Dual-earner couples and the decision to work less: A conceptual model

This paper examines the factors that affect the decision made by dual-earner couples concerning the possibility of one (or both) partners working a reduced-hours schedule. We rely on a comprehensive review of the literature on part-time work among dual-earner couples and on the factors that affect the decisions couples make about their work hours as well as preliminary findings from our ongoing study to consider two key questions: (1) What factors do dual-earner couples take into account when they consider whether one or both might work a reduced-hours schedule? (2) If the couple decides that one partner will work a reduced-hours schedule, how do they decide which partner reduces the hours of employment? Most previous research has focused on the centrality of gender in the decisions that couples make concerning the hours that they work. However, our review of the literature and the preliminary findings of our current research suggest that there are other factors that affect (directly or indirectly) the couples' decisions related to part-time options. Based on this review we present a new decision-making model for two-earner couples that will have implications for future research and policy initiatives. This paper is particularly timely for several reasons: the number of dual-earner couples continues to increase; there is some indication that more employees would choose to reduce their work hours if that were a viable option; and recently, managers and professional workers have become more vocal about their interest in part-time career options.     

Older women's fears of violence: the need for interventions that enable active ageing

Women's fear of violence can impact negatively on their active participation in life. An ageing survey conducted with 2,620 Australian respondents aged 50 to 90 years examined aspects of work, learning, social, spiritual and emotional status, health, vision, home, life events, demographics, and asked an open-ended question about what being actively engaged in life meant. Ordinal regression was carried out on two dependent variables: wanting and needing to learn to discourage violence. Analyses found that as women's age increased, those on lower incomes were more likely than others to say they needed to learn how to discourage violence against them. This paper investigates the variables associated with the findings-transport, finances, news media, home safety, and reduced social interactions. Results highlight the importance of understanding women's fear in the context of personal and social issues, and the need to provide learning opportunities to improve safety and social engagement.     

Preface: Women and Work: Where Are We, Where Did We Come From, and Where Are We Going?

The obstacles faced by today's women in the workplace bear out the truth in the old adage that history repeats itself. The maternal wall, the ideal worker, and the ideal homemaker beliefs are current iterations of the century-old tendency to mark women as suited for the home and men as suited for the workplace ( Albee & Perry, 1998 ; Coltrane, 1996 ; Mintz, 2000 ). The belief that the sexes are vastly different—with different needs, values, and abilities—has been a hallmark throughout the history of both women and men in both the workplace and the home ( Ferree, 1990 ; Williams, 2000 ). Generally speaking, these beliefs have been detrimental to all concerned ( Barnett & Rivers, 2004 ).     

Squaring the welfare circle and government ideology: Greece and Spain in the 1990s

This article examines the "squaring the welfare circle" thesis and its usefulness to our understanding of welfare developments in Greece and Spain in the 1990s. The welfare state in both Greece and Spain was expanded considerably in the early 1980s by the newly elected socialist governments, only to hit the buffers of diminishing resources and rising demands in the late 1980s as well as the hostile neo-liberal welfare ideology. The process of welfare expansion was halted in the 1990s, labour market deregulation was encouraged and containment of welfare expenditure became the dominant aim of government policies. This article concentrates on the actual policies of governments in the 1990s rather than on the rhetoric of political parties. It concludes that governments of both the Left and the Right in both countries attempted to "square the welfare circle" mainly through reductions in the supply of welfare. This general conclusion is country-specific and may not apply to other countries involved in welfare restructuring. While recognizing the significance of institutional factors to welfare reform, the article concentrates on the outcomes of reforms rather than on the political process leading to them.