Policy and practices relating to the active engagement of older people in the community: a comparison of Sweden and Australia

This article compares policy and practices for engaging older people in community life in Sweden and Australia. Barriers and support for active engagement through paid work, social activism, volunteering and aged services are compared. Both countries face issues of ageing populations, services for rural areas and people with small needs. Issues for Sweden were the absence of age discrimination legislation, availability of funds and lack of recognition of the growing levels of volunteering. Issues for Australia concerned the new managerialist approach to services, with associated complexities of access and limited social activism.     

Conditional approval: discussion points from the PSI conditional approval expert group

The European Agency for the Evaluation of Medicinal Products has recently completed the consultation of a draft guidance on how to implement conditional approval. This route of application is available for orphan drugs, emergency situations and serious debilitating or life-threatening diseases. Although there has been limited experience in implementing conditional approval to date, PSI (Statisticians in the Pharmaceutical Industry) sponsored a meeting of pharmaceutical statisticians with an interest in the area to discuss potential issues. This article outlines the issues raised and resulting discussions, based on the group's interpretation of the legislation. Conditional approval seems to fit well with the accepted regulatory strategy in HIV. In oncology, conditional approval may be most likely when (a) compelling phase II data are available using accepted clinical outcomes (e.g. progression/recurrence-free survival or overall survival) and Phase III has been planned or started, or (b) when data are available using a surrogate endpoint for clinical outcome (e.g. response rate or biochemical measures) from a single-arm study in rare tumours with high response, compared with historical data. The use of interim analyses in Phase III for supporting conditional approval raises some challenging issues regarding dissemination of information, maintenance of blinding, potential introduction of bias, ethics, switching, etc.     

Caring and the generation of social capital: Two models for a positive relationship

Johansson S, Leonard R, Noonan K. Caring and the generation of social capital: two models for a positive relationship When caring is linked to social capital, it is generally assumed that the nature of the relationship is that social capital is a resource that can be used for care work. When there is inadequate funding of aged care services by the state, then social capital may be seen as a substitute for economic and human capital. Caring, therefore, is seen as a drain on capital. However, this does not have to be the case. Aged care services, if thoughtfully designed, can not only consume social capital, but also generate it. Two models of elder care, one Swedish and one Australian, have been identified which specifically address the generation of social capital. In each case, the services and facilities have been developed by third‐sector organisations with a strong community development focus, often in the face of resistance from state‐run or medically oriented services.     

Neighborhood disadvantage and anger among older adults: social comparisons as effect modifiers

Using data from a sample of 1,136 adults ages 65 and older in the District of Columbia and two adjoining counties in Maryland, we examine the association between neighborhood structural disadvantage and levels of anger. In addition, we test whether subjective financial comparisons with neighbors modify those effects differently for elders at different levels of income. We find that the association between neighborhood disadvantage and anger is positive among lower-income elders who feel financially advantaged relative to their neighbors. In contrast, the association between neighborhood disadvantage and anger is positive among higher-income elders who feel financially disadvantaged relative to their neighbors. Irrespective of income, neighborhood disadvantage is unrelated to anger among people who feel financially similar to their neighbors. We discuss the implications of our findings for the study of neighborhood context and health, underscoring interrelationships among inequality, social comparisons, and the stress process.     

Formative evaluation of a motivational intervention for increasing physical activity in underserved youth

The present study was designed to develop an innovative motivational intervention (based on Self-Determination Theory and Social Cognitive Theory) to increase physical activity (PA) in underserved adolescents. Sixty-four adolescents (35 females, 29 males; 50% minority; 65% on reduced lunch program; ages 11-13 yr) participated in either an 8-week motivational intervention after-school (n = 32) or a typical after-school program (n = 32). The conceptual framework for the intervention targeted the social environment (perceived autonomy, perceived social support, participation, fun), cognitive mediators (perceived choice, self-efficacy, and relatedness/belongingness), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Formative evaluation data was collected by staff through daily forms throughout the 8-week program and through observational data completed by independent objective observers during 2 weeks of the program. The major themes that were identified addressed theoretical concepts regarding the intervention and logistical issues in delivering the intervention. The data revealed information regarding the importance of the cognitive appropriateness of the PA and motivational activities, the environmental climate for promoting nurturing relationships, developing specific strategies for increasing intrinsic rather than extrinsic reinforcement, and developing methods for preventing social "cliques" and gender conflicts to maintain an appropriate level of support in the social climate. Themes for training staff included focusing on team building, leadership, and nurturing. This formative evaluation is being used to formalize a randomized trial to test the effects of a student-centered motivational intervention on increasing PA in underserved 6th graders.     

Missing data: Discussion points from the PSI missing data expert group

The Points to Consider Document on Missing Data was adopted by the Committee of Health and Medicinal Products (CHMP) in December 2001. In September 2007 the CHMP issued a recommendation to review the document, with particular emphasis on summarizing and critically appraising the pattern of drop‐outs, explaining the role and limitations of the ‘last observation carried forward’ method and describing the CHMP's cautionary stance on the use of mixed models. In preparation for the release of the updated guidance document, statisticians in the Pharmaceutical Industry held a one‐day expert group meeting in September 2008. Topics that were debated included minimizing the extent of missing data and understanding the missing data mechanism, defining the principles for handling missing data and understanding the assumptions underlying different analysis methods. A clear message from the meeting was that at present, biostatisticians tend only to react to missing data. Limited pro‐active planning is undertaken when designing clinical trials. Missing data mechanisms for a trial need to be considered during the planning phase and the impact on the objectives assessed. Another area for improvement is in the understanding of the pattern of missing data observed during a trial and thus the missing data mechanism via the plotting of data; for example, use of Kaplan–Meier curves looking at time to withdrawal. Copyright © 2009 John Wiley & Sons, Ltd.     

How common is intersex? a response to Anne Fausto-Sterling

Anne Fausto-Sterling s suggestion that the prevalence of intersex might be as high as 1.7% has attracted wide attention in both the scholarly press and the popular media. Many reviewers are not aware that this figure includes conditions which most clinicians do not recognize as intersex, such as Klinefelter syndrome, Turner syndrome, and late-onset adrenal hyperplasia. If the term intersex is to retain any meaning, the term should be restricted to those conditions in which chromosomal sex is inconsistent with phenotypic sex, or in which the phenotype is not classifiable as either male or female. Applying this more precise definition, the true prevalence of intersex is seen to be about 0.018%, almost 100 times lower than Fausto-Sterling s estimate of 1.7%.     

Multi-Organizational Fields and Social Movement Organization Frame Content: The Religious Fro-Choice Movement*

As an explanatory method in studies of social movements, analyses of collective action frames have generally focused on the variable efficacy of the frames of social movement organizations (SMOs)in the mobilization of potential participants. However, this work has for practical reasons used the acknowledged analytic simplification that SMOs only target potential participants–and not opponents, elite decision makers, or the media–when constructing their frames. To incorporate multiple targets into future studies of SMO frame construction, this paper expands on the idea of a multi-organizational field. I propose that the characteristics of the targets in the field and the social structural and cognitive boundaries between them determine SMO frames. This perspective is demonstrated by analyzing changes in the collective action frames of SMOs in the religious pro-choice movement from 1967 to 1992. I argue that this perspective may explain findings where a frame fails to “resonate” with potential participants–the frame may not have been created with them in mind.