Characteristics of effective providers of marital and family therapy in rural mental health settings

Characteristics of effective providers of marital and family therapy (MFT) in rural mental health settings were investigated. The survey sample included 74 members of the National Association for Rural Mental Health who, through a modified Delphi process, created a composite picture of effective MFT providers. The findings yielded six major rank-ordered characteristics of effective MFT providers in rural mental health settings, with effective skills in MFT ranked first. Rural community understanding, appreciation and participation ranked second. Specific competencies contributing to each major characteristic were also identified and are discussed. Recommendations for use of this information are provided.     

Physical and mental health effects of being stalked for men and women

Stalking is relatively common yet little is known of the longer-term health effects of stalking. Using the National Violence Against Women survey, we estimated lifetime stalking victimization among women and men, ages 18 to 65, identified correlates of being stalked, and explored the association between being stalked and mental and physical health status. With a criterion of being stalked on more than one occasion and being at least "somewhat afraid," 14.2% of women and 4.3% of men were victims. Among those stalked, 41% of women and 28% of men were stalked by an intimate partner. Women were more than 13 times as likely to be "very afraid" of their stalker than men. Negative health consequences of being stalked were similar for men and women; those stalked were significantly more likely to report poor current health, depression, injury, and substance use. Implications for victims, service providers, and the criminal justice system were reviewed.     

Alcohol and substance use disorders as predictors of child to adult sexual revictimization in a sample of community women

Alcohol- and substance-related diagnoses were examined as factors in child to adult sexual revictimization. Three hundred community women completed interviews and self-report instruments to obtain information regarding victimization and to diagnose substance use disorders (alcohol and substance abuse/dependence). Childhood sexual abuse (CSA) survivors were more likely than nonvictims to meet criteria for both substance use disorders and to report rape (e.g., unwanted intercourse due to threat or use of force, or due to the inability to consent due to the respondent's alcohol or drug use) and coerced intercourse (e.g., unwanted intercourse due to verbal coercion or misuse of authority by the perpetrator) by acquaintances, strangers, and husbands. In general, both CSA and substance use disorders were predictive of adult sexual victimization, but there were no significant interactions between these factors. Overall, substance use disorders were related to rape for all women; this relationship was not unique to CSA survivors. Alcohol- and substance-related diagnoses predicted rape by all three types of perpetrators, but CSA was predictive of rape only by acquaintances and strangers and not husbands. In contrast, CSA predicted coerced intercourse by all three perpetrators, while alcohol- and substance-related diagnoses predicted coerced intercourse by acquaintances and strangers, but not husbands. Results highlight the need to continue the study of revictimization of CSA survivors, including examination of both rape and sexually coercive experiences by different types of perpetrators. Findings support continued research of substance use disorders as risk factors for sexual victimization among all women.     

Violence and gender: reports from an urban high school

This article reports on the survey component of a study examining urban high school students' experiences with violence. The survey's purpose was to collect information on students' experiences with violence, explore gender differences, and identify which factors are associated with the self-reported use of violence. Two prominent risk factors for the self-reported use of violence were found: having a close friend or family member injured by violence, and gun possession. Young men and women did not differ significantly in overall exposure, victimization, and perpetration. However, gender clearly informed the types of violence reported. The findings offer practical strategies for addressing adolescent violence, such as reducing gun availability and community-level violence, but future research must further examine the role of gender in order to structure more effective prevention and intervention approaches that target different kinds of violence.     

Evaluation of an upper extremity student-role functioning scale using item response theory

Millions of workers suffer from upper extremity (musculoskeletal) disorders. Many of these workers are predisposed to upper extremity musculoskeletal disorders because of early exposure to ergonomic risks as students. Computer usage for four or more hours remains the greatest risk for upper extremity musculoskeletal disorders for workers and students alike. Developing preventative methods to reduce student exposure, and thus protect future workers from upper extremity musculoskeletal disorders later in life, requires an appropriate measure for upper extremity musculoskeletal disorder prevalence and related limitations for student functioning. Item response theory analysis was used to evaluate and further develop a upper extremity functioning scale for the student role.     

Introduction: moving youth participation forward

Given the emerging interest among researchers, practitioners, and policymakers in youth participation, it is important to examine and assess carefully the promise and challenges of youth engagement.     

Error catastrophe in mutant mitochondria

The error catastrophe theory of aging, proposed by Orgel in 1963, predicted a decrease in the fidelity of information transfer that accelerated as aging progressed, until properly functioning macromolecules could no longer be reliably made. The theory was extensively tested by comparing DNA polymerases, transfer RNAs, and proteins derived from aging versus young animals, but it did not prove to have general applicability to the process of aging. Recently, the heritable eye disorder progressive external ophthalmoplegia has been found to result from mutation of the gene encoding DNA polymerase gamma, which replicates mitochondrial DNA. The mutant form of the polymerase replicates DNA less accurately than the wild-type enzyme, providing an explanation for the accumulation of mutations in the mitochondrial DNA of patients with this disorder. The affected mitochondria appear to exhibit an age-dependent error catastrophe. It is possible that other genetic diseases might result in error catastrophes in mitochondria as well.     

Choice of Parametric Accelerated Life and Proportional Hazards Models for Survival Data: Asymptotic Results

We discuss the impact of misspecifying fully parametric proportional hazards and accelerated life models. For the uncensored case, misspecified accelerated life models give asymptotically unbiased estimates of covariate effect, but the shape and scale parameters depend on the misspecification. The covariate, shape and scale parameters differ in the censored case. Parametric proportional hazards models do not have a sound justification for general use: estimates from misspecified models can be very biased, and misleading results for the shape of the hazard function can arise. Misspecified survival functions are more biased at the extremes than the centre. Asymptotic and first order results are compared. If a model is misspecified, the size of Wald tests will be underestimated. Use of the sandwich estimator of standard error gives tests of the correct size, but misspecification leads to a loss of power. Accelerated life models are more robust to misspecification because of their log-linear form. In preliminary data analysis, practitioners should investigate proportional hazards and accelerated life models; software is readily available for several such models.     

Life cycle impact assessment: a challenge for risk analysts.

Modern technology, together with an advanced economy, can provide a good or service in myriad ways, giving us choices on what to produce and how to produce it. To make those choices more intelligently, society needs to know not only the market price of each alternative, but the associated health and environmental consequences. A fair comparison requires evaluating the consequences across the whole "life cycle"--from the extraction of raw materials and processing to manufacture/construction, use, and end-of-life--of each alternative. Focusing on only one stage (e.g., manufacture) of the life cycle is often misleading. Unfortunately, analysts and researchers still have only rudimentary tools to quantify the materials and energy inputs and the resulting damage to health and the environment. Life cycle assessment (LCA) provides an overall framework for identifying and evaluating these implications. Since the 1960s, considerable progress has been made in developing methods for LCA, especially in characterizing, qualitatively and quantitatively, environmental discharges. However, few of these analyses have attempted to assess the quantitative impact on the environment and health of material inputs and environmental discharges Risk analysis and LCA are connected closely. While risk analysis has characterized and quantified the health risks of exposure to a toxicant, the policy implications have not been clear. Inferring that an occupational or public health exposure carries a nontrivial risk is only the first step in formulating a policy response. A broader framework, including LCA, is needed to see which response is likely to lower the risk without creating high risks elsewhere. Even more important, LCA has floundered at the stage of translating an inventory of environmental discharges into estimates of impact on health and the environment. Without the impact analysis, policymakers must revert to some simple rule, such as that all discharges, regardless of which chemical, which medium, and where they are discharged, are equally toxic. Thus, risk analysts should seek LCA guidance in translating a risk analysis into policy conclusions or even advice to those at risk. LCA needs the help of RA to go beyond simplistic assumptions about the implications of a discharge inventory. We demonstrate the need and rationale for LCA, present a brief history of LCA, present examples of the application of this tool, note the limitations of LCA models, and present several methods for incorporating risk assessment into LCA. However, we warn the reader not to expect too much. A comprehensive comparison of the health and environmental implications of alternatives is beyond the state of the art. LCA is currently not able to provide risk analysts with detailed information on the chemical form and location of the environmental discharges that would allow detailed estimation of the risks to individuals due to toxicants. For example, a challenge for risk analysts is to estimate health and other risks where the location and chemical speciation are not characterized precisely. Providing valuable information to decisionmakers requires advances in both LCA and risk analysis. These two disciplines should be closely linked, since each has much to contribute to the other.     

Measurement error, skewness, and risk analysis: coping with the long tail of the distribution.

Probabilistic risk analyses often construct multistage chance trees to estimate the joint probability of compound events. If random measurement error is associated with some or all of the estimates, we show that resulting estimates of joint probability may be highly skewed. Joint probability estimates based on the analysis of multistage chance trees are more likely than not to be below the true probability of adverse events, but will sometimes substantially overestimate them. In contexts such as insurance markets for environmental risks, skewed distributions of risk estimates amplify the "winner's curse" so that the estimated risk premium for low-probability events is likely to be lower than the normative value. Skewness may result even in unbiased estimators of expected value from simple lotteries, if measurement error is associated with both the probability and pay-off terms. Further, skewness may occur even if the error associated with these two estimates is symmetrically distributed. Under certain circumstances, skewed estimates of expected value may result in risk-neutral decisionmakers exhibiting a tendency to choose a certainty equivalent over a lottery of equal expected value, or vice versa. We show that when distributions of estimates of expected value are, positively skewed, under certain circumstances it will be optimal to choose lotteries with nominal values lower than the value of apparently superior certainty equivalents. Extending the previous work of Goodman (1960), we provide an exact formula for the skewness of products.