The development of the physicians' end-of-life care attitude scale

The Physicians' End-of-Life Care Attitude Scale (PEAS) was developed as an outcome measure for palliative care education. PEAS assesses the willingness of medical trainees to care for dying patients. Sixty-four Likert-type questions were created on the basis of discussions with focus groups of medical trainees, then administered to sixty-two medical students and residents. Total PEAS scores as well as personal preparation and professional role subscales (where higher scores indicated greater concern) possessed excellent internal consistency and reliability. In addition, there were substantial correlations between PEAS scores and the CA-Dying scale, a measurement of laypersons' fears about interacting with dying persons. Thus, PEAS adequately assesses the unique communication concerns of physicians in training regarding working with dying persons and their families. Correlations between PEAS scores and age were negative, while those who had experienced the death of a loved one had higher PEAS scores than those who did not. This suggests that for some persons, life experiences may lessen difficulties in dealing with dying persons, while for others, personal losses may exacerbate such concerns. The utility of PEAS in evaluating the efficacy of palliative care education as well as its potential to measure medical trainee's willingness to care for the terminally ill is discussed.     

领导人哪去了

所有的领导人哪里去了?政界人士与工商界的人们均在提出这个问题。当前,大家都在找寻某个人,希望他能挺身而出,将大家拯救于金融危机之中,或帮助大家解决难以驾驭的外交冲突。克林顿被逼到墙脚美国和俄国的总统,即比尔·克林顿与鲍里斯·叶利钦明显地已经没有胜出的希望。克林顿已经被逼到墙脚。而叶利钦则在此次俄国金融体系崩塌中广泛地失去声望与信任。德国与日本亦未能提     

疫苗外交

消除疾病的国际努力不仅挽救了生命,而且能预防冲突。     

创业家的5种态度

我们可以通过模仿成功创业家的五个核心态度来理解根本的企业问题，从而点亮创业之旅。     

Wife killing: risk to women as a function of age

Younger women, relative to older women, incur elevated risk of uxoricide-being murdered by their husbands. Some evolutionary theorists attribute this pattern to men's evolved sexual proprietariness, which inclines them to use violence to control women, especially those high in reproductive value. Other evolutionary theorists propose an evolved homicide module for wife killing. An alternative to both explanations is that young women experience elevated uxoricide risk as an incidental byproduct of marriage to younger men who commit the majority of acts of violence. We used a sample of 13,670 uxoricides to test these alternative explanations. Findings show that (a) reproductive-age women incur an elevated risk of uxoricide relative to older women; (b) younger men are overrepresented among uxoricide perpetrators; and (c) younger women, even when married to older men, still incur excess risk of uxoricide. Discussion examines competing explanations for uxoricide in light of these findings.     

IntroductionExposing Misinformation Concerning Child Sexual Abuse and Adult Survivors

This article introduces a special volume on misinformation about child sexual abuse. Despite extensive research findings on the long-term effects and consequences of child sexual abuse, misinformation on this topic is widespread. Several forces have worked to support and disseminate this erroneous information. Because it is difficult to comprehend the horror of sexual crimes against children, society's denial and disbelief have often unwittingly supported the agendas of those who want to discount or minimize the impact of these crimes. The media has also contributed to the aura of skepticism surrounding claims of sexual abuse and its mental health impact, and has reported favorably on controversial and unproven claims such as the “false memory syndrome.” In the hope of countering misinformation and thus raising the level of discourse to the engagement of real scientific issues, a number of well known and respected researchers and clinicians examine various facets of the problem.     

Nonparametric Tests for Stratum Effects in the Cox Model

Thispaper considers the stratified proportional hazards model witha focus on the assessment of stratum effects. The assessmentof such effects is often of interest, for example, in clinicaltrials. In this case, two relevant tests are the test of stratuminteraction with covariates and the test of stratum interactionwith baseline hazard functions. For the test of stratum interactionwith covariates, one can use the partial likelihood method (Kalbfleischand Prentice, 1980; Lin, 1994). For the test of stratum interactionwith baseline hazard functions, however, there seems to be noformal test available. We consider this problem and propose aclass of nonparametric tests. The asymptotic distributions ofthe tests are derived using the martingale theory. The proposedtests can also be used for survival comparisons which need tobe adjusted for covariate effects. The method is illustratedwith data from a lung cancer clinical trial.     

Dependence Estimation Over a Finite Bivariate Failure Time Region

This articleconcerns nonparametric estimation of association between bivariatefailure times. In the presence of independent right censoring,the support for failure time variates may be restricted and measuresof dependence over a finite failure time region may be of particularinterest. To this end, the reciprocal cross ratio function, weightedby the bivariate failure time density, is proposed as a summarymeasure of dependence over a failure time region. This `relativerisk' estimator is shown to be consistent and asymptoticallynormally distributed, with consistent bootstrap variance estimator.A finite-region version of Kendall's tau, which is suitable forcensored failure time data, is also proposed, and correspondingasymptotic distribution theory is noted. The accuracy of theseasymptotic approximations is studied in simulations and an illustrationis provided.     

"At my age I should be sitting under that tree": the impact of AIDS on Tanzanian lakeshore communities

In 1992, the author led a participatory rural appraisal (PRA) exercise for a community fisheries project in Kagera region, on the western side of Lake Victoria, Tanzania. The PRA team visited four settlements: the prime harbor settlement on Kerebe Island; N'toro beach, in Bukoba district, near the Ugandan border; Chamkwikwi landing site in Muleba district; and Buzirayombo bay settlement in Biharamulo district in the south. This article draws on that research, to give an outsider's analysis of the ways in which AIDS was changing livelihoods in poor fishing and farming communities. On the lakeshore and islands, adults were falling ill and dying. This loss of men and women in their prime was causing major economic and social stresses for the single parents, grandparents, and orphans whom the authors met. They showed resilience and adaptability in the face of this threat to their already precarious livelihoods. The article ends by suggesting ways in which development policy makers and practitioners should support livelihoods in the era of AIDS.     

Work rehabilitation programs: a 1997 survey

By adapting to the changing health care environment, legislative reforms, and consumer needs, work rehabilitation programs have experienced a metamorphosis. This study surveyed occupational therapists currently employed in work programs to ascertain a current demographic profile of work rehabilitation programs. Respondents indicated the delivery of services in the areas of prevention, assessment and rehabilitation. The majority of work rehabilitation programs in this study provide services in the form of ergonomics, education and training, and job analyses at the worksite. The area of work injury prevention services is forecasted for increased growth among work rehabilitation programs.