ASEXUally: On Being an Ally to the Asexual Community

The development of allies is crucial to the asexual population. The asexual community is among the most under- researched and poorly understood sexual minority populations. Through discussion of basic information on asexuality, the distinction between asexuality and a diagnosable disorder, and ways that other identities intersect with asexuality, this article offers a foundation and model for asexual ally development. Based on the information presented, recommendations for counselor and counselor educator allies who are working with asexual identified, or potentially asexual individuals, are presented. Suggestions for future research on asexuality are also explored.     

Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Background

Extremity injuries (EI) and dementia are important causes of long-term care (LTC), but they can also cause each other and are often present concurrently. Mobility-limiting EI can increase the risk of dementia, and dementia increases the risk for falls, which are often the cause of EI. When EI and dementia are present together, they can increase their negative effect on long-term care risk. This study aims to assess the strength of this interaction and the role of different body regions and severities of EI regarding LTC risk.

Methods

We use Cox proportional-hazard models on LTC as dependent variable. EI (primarily fractures) and dementia (all types) are the central independent variables. We control for age, sex, rehabilitation and 18 relevant comorbidities. Analyses are based on health claims records for 2004–2010 for a random sample of about 122.000 insurants of Germany's largest public health insurance "AOK" aged 65+, about 25.000 of whom entered LTC.

Results

Without concurrent dementia, non-severe EI (NSEI) of the lower and both extremities and all kinds of severe EI (SEI) increase LTC risk (HR: hazard ratio with 95% confidence interval. Lower NSEI: HR?=?1.09 [1.05–1.14]; both NSEI: HR?=?1.36 [1.29–1.44]. Lower SEI: HR?=?1.67 [1.57–1.79]; upper SEI: HR?=?1.27 [1.19–1.37]; both SEI: HR?=?1.94 [1.81–2.07]). Dementia alone increases LTC risk more than fourfold (HR?=?4.23 [4.11–4.35]).Taking the interaction of EI and dementia into account, the concurrent presence of EI and dementia tends to increase the LTC risk more than expected for lower as well as upper NSEI and SEI. Summarily, when lower or upper EI and dementia are both present, the LTC risk tends to be higher than expected, suggesting synergistic effects.

Conclusions

EI and dementia are important independent risk factors for long-term care. When lower or upper EI and dementia are present together, the resulting long-term care risk is increased disproportionately. Since the concurrent presence of both conditions increases the risk for care need, and a working treatment for dementia is not in sight, preventing EI, lessening the impact of EI and improving the outlook after an EI could help to reduce LTC need in the coming decades.

     

Contemporary Epidemiology: A Review of Critical Discussions Within the Discipline and A Call for Further Dialogue with Social Theory

The discipline of epidemiology, which holds major influence on public health policy as well as on clinical medical practice, has in recent decades to a large extent been concerned with the identification of factors and markers of risk for disease. Much health information and intervention is thus informed by a wealth of studies on a variety of risk factors, of which the individual is encouraged to keep informed and to be responsible about. Meanwhile, risk factor epidemiology has been subject to intense debate, both within and outside the discipline. The following review offers an overview of critical intradisciplinary debates. It then opens discussion on three partially overlapping areas where social theory has been called upon to contribute to epidemiological inquiry, namely analysis of macro‐social determinants of health and disease, of categories of human difference and of embodiment. The review ends with, and is motivated by, a plea for further integration of and dialogue between epidemiology and social theory.     

Collaborative Partnership in Age-Friendly Cities: Two Case Studies From Quebec,Canada

This article aims to explain the collaborative partnership conditions and factors that foster implementation effectiveness within the age-friendly cities (AFC) in Quebec (AFC-QC), Canada. Based on a community-building approach that emphasizes collaborative partnership, the AFC-QC implementation process is divided into three steps: (1) social diagnostic of older adults' needs; (2) an action plan based on a logic model; and (3) implementation through collaborations. AFC-QC promotes direct involvement of older adults and seniors' associations at each of the three steps of the implementation process, as well as other stakeholders in the community. Based on two contrasting case studies, this article illustrates the importance of collaborative partnership for the success of AFC implementation. Results show that stakeholders, agencies, and organizations are exposed to a new form of governance where coordination and collaborative partnership among members of the steering committee are essential. Furthermore, despite the importance of the senior associations' participation in the process, they encountered significant limits in the capacity of implementing age-friendly environments solely by themselves. In conclusion, we identify the main collaborative partnership conditions and factors in AFC-QC.     

Under-detection of autism among First Nations children in British Columbia,Canada

This article shows that First Nations children diagnosed with autism in British Columbia, Canada are under-represented in publications regarding autism and the prevalence thereof, and that this group appears to be under-detected. The aim of this review of publications regarding autism and aboriginal populations in Canada and other countries is to examine possible explanations. The research review results suggest that possible reasons for under-detection of autism among aboriginal populations, and consequently First Nations peoples, can be diagnostic substitution and symptom presentation, ethnic or cultural, area of residence or the impact of historical oppression and discrimination.     

Grandparents raising grandchildren: negotiating the complexities of role‐identity conflict

The purpose of this qualitative study was to better understand the experience of grandparents who are raising their grandchildren in New South Wales, Australia. In‐depth interviews were conducted with 34 grandparents and their narratives transcribed and studied using paradigmatic analysis to reveal common themes among the stories told. Identity theory further informed the discussion of these findings. Woven throughout the grandparent narratives is a story of paradox – of experience simultaneously made up of pain/pleasure, myth/reality, inclusion/exclusion, being deserving/undeserving, visible/invisible and voiced/silenced. The findings signal a significant role‐identity conflict for grandparents who are parenting grandchildren. This study points to the need for policy and practice that more closely reflects the complexity of experience associated with the grandparent‐as‐parent role.     

Location of Public Goods and the Calculus of Voting: The Seattle Monorail Referendum*

Objectives. In this article we explore how the geographic location of a proposed public good on the ballot in a local referendum influences voting turnout. We argue that voters who live farther away from the good, and are thus likely to bear the cost of the good but have no access to it, would be more motivated to turn out in the election. Drawing on the cost‐orientation hypothesis, or negativity effect, “that people are more strongly motivated to avoid losses than to approach gains,” we expect these voters to derive higher expressive benefits from the act of voting relative to those of voters located closer to the good. Methods. We examine voting turnout in the 2002 referendum in the City of Seattle on the proposed construction of a monorail. We conduct our study at the precinct level using spatial tools of analysis. We evaluate the effect of accessibility on turnout by means of a curvilinear model that incorporates demographic and political variables. Results. We find that voting turnout is determined partly by accessibility. Turnout is higher in precincts located farther away from the monorail line than in precincts located relatively closer to the line. Partisanship conditions this effect. Conclusions. This study provides tentative support for linking voter turnout to the negativity effect via expressive benefits. Voters' location in relation to a public good may affect directly their political behavior by means of their perceived net gains or losses from the good.     

Riemann sums for MCMC estimation and convergence monitoring

This paper develops an extension of the Riemann sum techniques of Philippe (J. Statist. Comput. Simul. 59: 295–314) in the setup of MCMC algorithms. It shows that these techniques apply equally well to the output of these algorithms, with similar speeds of convergence which improve upon the regular estimator. The restriction on the dimension associated with Riemann sums can furthermore be overcome by Rao–Blackwellization methods. This approach can also be used as a control variate technique in convergence assessment of MCMC algorithms, either by comparing the values of alternative versions of Riemann sums, which estimate the same quantity, or by using genuine control variate, that is, functions with known expectations, which are available in full generality for constants and scores.     

'Working at Disability': a qualitative study of the meaning of health and disability for women with physical impairments

Seven women with cerebral palsy and one woman with a spinal cord injury were interviewed about the meaning of health and disability in their lives. The most compelling feature of their narratives was the pressure to define their health by able-bodied standards. These women 'worked at' fitting their bodies and experiences into the limited societal understanding of a body. Paradoxically, the women seemed to come to a deeper personal understanding of disability and themselves through this work. The women's stories of health, impairment and disability, as told in the interviews, blended into rich chapters of their life stories.