Multiparameter evidence synthesis in epidemiology and medical decision-making: current approaches

Summary.  Alongside the development of meta-analysis as a tool for summarizing research literature, there is renewed interest in broader forms of quantitative synthesis that are aimed at combining evidence from different study designs or evidence on multiple parameters. These have been proposed under various headings: the confidence profile method, cross-design synthesis, hierarchical models and generalized evidence synthesis. Models that are used in health technology assessment are also referred to as representing a synthesis of evidence in a mathematical structure. Here we review alternative approaches to statistical evidence synthesis, and their implications for epidemiology and medical decision-making. The methods include hierarchical models, models informed by evidence on different functions of several parameters and models incorporating both of these features. The need to check for consistency of evidence when using these powerful methods is emphasized. We develop a rationale for evidence synthesis that is based on Bayesian decision modelling and expected value of information theory, which stresses not only the need for a lack of bias in estimates of treatment effects but also a lack of bias in assessments of uncertainty. The increasing reliance of governmental bodies like the UK National Institute for Clinical Excellence on complex evidence synthesis in decision modelling is discussed.     

Psychological Distress,Couple Interactions,and Parenting: A Dyadic Analysis of African American Couples

Parental depression is a well‐established risk factor for couple conflict and ineffective or hostile parenting (M. C. Lovejoy, P. A. Graczyk, E. O'Hare, & G. Neuman, 2000; L. M. Papp, M. C. Goeke‐Morey, & E. M. Cummings, 2007). Although research suggests that caregiver depression may impact parenting indirectly via increased conflict between couples (e.g., R. D. Conger et al., 2002), few studies take into account the behaviors of both caregivers in exploring these relations. The goal of the current study is to employ an actor–partner mediator model to examine the complex relations among psychological distress, negative couple interactions, and parenting. Using a sample of 162 African American couples with children, we find evidence that the psychological distress of each caregiver has an effect on couple interactions for both men and women. The effects from each caregivers' distress to parenting are mainly indirect through the interactional behaviors of the mother toward the father, consistent with the father vulnerability hypothesis (e.g., E. M. Cummings, M. Goeke‐Morey, & J. Raymond, 2004).     

Endless Pressure: Life on a Low Income in Austere Times

Much has been written that details the decline in living standards following the ‘credit crunch’ in the UK. It remains that we understand to a lesser degree the lived reality of poverty through the Great Recession and into the era of austerity. This article draws on testimonies of 62 participants from low income households conducted in three different areas of the UK during 2012–13 to document the pressures that this period brought to bear on these households. According to these testimonies, the experience of poverty intensified in key respects: first, participants reported feeling, more than ever before, that they were ‘existing, rather than living’ due to the meagre budgets they were forced to live on; second, the precarious nature of work and social security contributed to a sense of insecurity that was all pervasive in our participants' lives; third, due to the pejorative political rhetoric and media coverage of poverty, our participants felt that their lives were placed under increased scrutiny which deleteriously impacted their wider relationships and sense of belonging. Our analysis demonstrates the profound consequences for those living on low incomes of the continued shift to residual forms of state welfare and the increased reliance on the ‘Big Society’ as a means to deal with the pressures identified in this article.     

How Resource Dependency Can Influence Social Resilience within a Primary Resource Industry*

Abstract Maintaining a healthy balance between human prosperity and environmental integrity is at the core of the principles of Ecological Sustainable Development. Resource‐protection policies are frequently implemented so as to regulate the balance between resource access and use, however, they can inadvertently compromise the ability of resource users to adapt and be resilient. Resource users who are especially dependent on a resource are more seriously compromised. But how do we define and measure resource dependency? And how do we assess its ability to influence social resilience? In this study, a conceptual model of resource dependency is developed in terms of: (i) occupational attachment, (ii) attachment to place, (iii) employability, (iv) family attitude to change, (v) business size, (vi) business approach, (vii) financial situation, (viii) level of specialisation, (ix) time spent harvesting, and (x) interest in and knowledge of the environment. The model of resource dependency and its effect on social resilience are (quantitatively and qualitatively) tested and explored using the commercial fishing industry in North Queensland, Australia. Results show that occupational attachment and employability were important influences as were business size and approach. Results can be used to identify vulnerability to institutional change and guide policy development processes.     

Putting the First Audience First: Conducting Useful Evaluation for a Risk-Related Government Agency

The risk communication practitioner in a government agency has two essential, interdependent tasks. One is to help develop and monitor effective communication programs with various external public audiences. The other task is to do the same thing for the senior government managers whose support is a prerequisite to addressing the first audience. Hence, the second audience–the manager–is really the first. This paper addresses ways in which communication practitioners can satisfy this crucial audience. A profile of these managers suggests that they would find it highly beneficial to have more control over the public problems they encounter, especially in view of the growing pressures to do more with less and demonstrate "customer satisfaction." They would rather avoid crises than manage them. And they would rather have their bosses praise their successes than challenge their budgets or punish their perceived difficulties or failures. Communication practitioners who can help them attain such benefits will find their efforts in great demand. They would be helpful team members who provide timely insights that can make and show agency success. We offer ten ways for communication practitioners to be more useful which focus their current strengths on satisfying senior managers'needs by becoming more valuable members of the program team. By becoming more useful to the senior manager they serve both the agency and its publics.     

Measuring The Effects Of Race Differentials In Mortality Upon Surviving Family Members

A model is developed to use marital history data from the U.S. Current Population Survey and mortality statistics from the federal registration system to estimate color differences in (a) the risk of widowhood among women in the working ages and (b) the cumulative duration of widowhood. Color differentials in mortality among married males are thereby translated into person-years of dependent survivorship among women, in anticipation of our later estimating average and cumulative lifetime income losses for the survivors. Initial results of this model, dealing with the demographic aspects of survivorship, are presented.     

Factors related to attitudes toward diversity in Australia,Malaysia, and Puerto Rico

In this study, we tested social identity complexity theory (Roccas & Brewer, 2002) in relation to attitudes toward diversity and the associated variables of patriotism, nationalism, religiosity, aggression, and sense of self (well-being) in a cross-cultural study of 398 Malaysian, 239 Australian, and 201 Puerto Rican students. Puerto Ricans reported the most positive attitudes toward diversity, followed by Australians, and finally Malaysians. For Puerto Ricans, pro-diversity attitudes were predicted by a positive correlation with constructive patriotism and a negative correlation with blind patriotism. For Australians, pro-diversity attitudes were predicted by a positive association with constructive patriotism, a negative association with traditional nationalism, and a negative association with physical aggression. For Malaysians, pro-diversity attitudes were predicted by positive relationships with all of the following variables: constructive patriotism, traditional nationalism, verbal aggression, hostility, and the need to bolster self through idealizing others. These results support social identity complexity theory and partially support associated predictions for Australians, Puerto Ricans, and some of the predictions for Malaysians. The results are explained in terms of local cultural contexts that may not easily be understood by a simple understanding of the variables that were measured.     

Effects of Aerobic Training on Primary Dysmenorrhea Symptomatology in College Females

Abstract

“Single-Dose Therapy for Cystitis in Women: A Comparison of Trimethoprim-Sulfamethoxazole, Amoxicillin, and Cyclacillin,” Thomas M. Hooton et al. We evaluated single-dose regimens of trimethoprim-sulfamethoxazole, amoxicillin, and cyclacillin as treatment for acute cystitis in 38 women. The trial was prematurely stopped because of frequent treatment failures. At two days after treatment, all 13 patients given trimethoprim-sulfamethoxazole were cured, while four (31%) of the 13 given amoxicillin and four (33%) of 12 given cyclacillin had persistent bacteriuria. At two weeks, 11 (85%) of 13 patients given trimethoprim-sulfamethoxazole, six (50%) of 12 given amoxicillin, and three (30%) of ten given cyclacillin were cured. One patient with positive results of antibody-coated bacteria testing who was treated with cyclacillin had signs and symptoms of acute pyelonephritis three days after treatment, and two patients treated with amoxicillin and one treated with trimethoprim-sulfamethoxazole converted antibody-coated bacteria test results from negative to positive after therapy. We conclude that single-dose treatment of cystitis in unselected women with cyclacillin and amoxicillin may result in low cure rates and that progression to acute pyelonephritis may occur following ineffective single-dose therapy. (Journal of the American Medical Association 1985;253:387-390.)