Pathologizing behavior: Meanings of behaviors in dementia care

Deficit and problem-based approaches to behavior stigmatize persons with dementia and cause great unnecessary suffering. In order to reduce the harm caused to persons misunderstood, it is important to understand the process by which staff attach meaning to behaviors and how those meanings ultimately influence how staff respond to behaviors. To this end, this research sought to examine the perceptions and meanings that staff attach to behaviors, how staff experience these behaviors, and the role that meanings and experiences have in staff actions and responses to specific behaviors. This paper focuses on one sensitizing concept that emerged from our study — pathologizing behavior — that reflects how behaviors become pathologized and problematized in the long-term care context. Conducted as part of a larger interpretive grounded theory study, active interviews were conducted with 48 staff members working in a range of positions in long-term care homes in Ontario, Canada. All staff interpreted and placed residents' behaviors in context through a complex process that started with the process of filtering behavior through the lens of pathology, and guided how staff then assigned meaning to the behaviors, how they characterized behaviors as “challenging”, and ultimately reacted through crisis management. The findings demonstrate the impact biomedical discourses have on meanings attached to behaviors and responses to behaviors and point to the need for alternative discourses that emphasize understanding meanings of actions using multidimensional lenses.     

Can we,should we,measure ethnicity?

Feminist social science is marked by its diversity, its ethos of inclusiveness and its critical power. These qualities are best exemplified in feminisms' acknowledgement, at the epistemological level, that men as well as women are crucial participants in the feminist enterprise. Moreover, epistemological justifications for positioning men within feminism is matched by a commitment to think through the methodological implications of men's involvement as both researchers and researched. In particular, inclusiveness pushes at the boundary of what counts as feminist methodology, and it forces us to rethink the underlying principles of feminist research work. In this article, two key feminist methodological principles—rapport and empathy, and democracy—are interrogated in the light of a series of in-depth interviews with a group of powerful, authoritative and uniformed men (senior police officers). It is suggested that while there may be a temptation to dismiss the interviewing relations which evolved as ‘non-feminist’, they are also indicative of feminist methodological vitality and strength as well as its capacity to accommodate the fractured subjectivities of research participants. The paper concludes by positing a re-conceptualization of interviewing principles which not only appreciate diversity in feminist epistemological and methodological commitments, but also variability and difference in feminist research relationships.     

The retrenchment of second‐tier pensions in Hungary and Poland: A precautionary tale

In 1997, Hungary and Poland led Central Europe in partially privatizing their national pension systems, diverting a portion of public pension contributions to privately‐managed individual investment accounts. In the aftermath of the global economic crisis, both governments retrenched these second‐tier schemes: Hungary (December 2010), by ceasing to fund the accounts and recouping most workers' existing balances; and Poland (April 2011), by reducing the diversion of contributions to the second tier. The factors that drove these retrenchments are traced to the original 1997 second‐tier designs, which omitted key specifications related to financing the accounts, private benefit design, and the regulation of private management fees. While both governments tried to compensate for the missing design specifications during implementation, the results were limited. By reducing investment returns and raising borrowing costs, the global economic crisis brought the problems to a head. The conclusion highlights some outstanding issues whose resolution will shape the retrenchments' long‐term impacts.     

Are Informal Connections a Functional Alternative to Associational Life in Enhancing Social Cohesion? Findings from Hong Kong

This article aims to ascertain whether organizational life and informal connections, which made up part of Putnam’s (Bowling alone: the collapse and revival of American community. Simon & Schuster, New York, 2000) Social Capital Index, have separate effects on social cohesion. Postulating that informal gatherings with family and friends might be a functional alternative to associational life, we employed multiple regression analysis to test the hypothesis. The analysis was based on a 2011 territory-wide door-to-door survey in Hong Kong. Controlling for the effects of demographic variables including gender, age, educational level, and employment status, it was found that formal participation in organizations contributed significantly to the explanation in five of the eight subindexes of social cohesion. In contrast, informal connections contributed significantly only to one subindex. The pattern persisted when attitudinal variables such as life satisfaction, social support, and perceived social class were added to the regression analysis. In short, our analysis demonstrated that participation in formal organizations fosters various aspects of social cohesion, and that this effect cannot be replaced by informal gatherings with family and friends.     

Childbearing traditions of Indian women at home and abroad: An integrative literature review

BackgroundThe percentage of overseas-born mothers giving birth in Australia has increased to 31.5% in 2012 and Indian women represent 10% (the highest proportion). It is important for midwives in Australia to be aware of the childbearing traditions of Indian women and how these influence Indian women birthing in Australia.AimTo explore childbearing practices in India and Indian women's experience of giving birth abroad; and to discuss the relevant findings for midwives working with Indian women in Australia.MethodAn integrative literature review was employed. 32 items, including 18 original research articles were thematically reviewed to identify commonly occurring themes relating to Indian women's childbearing traditions.FindingsFive themes relating to traditional childbearing practices of women birthing in India were identified. These themes included diversity and disparity; social context of childbirth and marriage; diet based on Ayurveda; pollution theory and confinement; and finally, rituals and customs.ConclusionIndian women giving birth abroad and by implication in Australia experience a transition to motherhood in a new culture. While adjusting to motherhood, they are also negotiating between their old and new cultural identities. To provide culturally safe care, it is essential that midwives reflect on their own culture while exploring what traditions are important for Indian women.     

Estimating Transition Probabilities for Ignorable Intermittent Missing Data in a Discrete-Time Markov Chain

This article considers a discrete-time Markov chain for modeling transition probabilities when multiple successive observations are missing at random between two observed outcomes using three methods: a na\"?ve analog of complete-case analysis using the observed one-step transitions alone, a non data-augmentation method (NL) by solving nonlinear equations, and a data-augmentation method, the Expectation-Maximization (EM) algorithm. The explicit form of the conditional log-likelihood given the observed information as required by the E step is provided, and the iterative formula in the M step is expressed in a closed form. An empirical study was performed to examine the accuracy and precision of the estimates obtained in the three methods under ignorable missing mechanisms of missing completely at random and missing at random. A dataset from the mental health arena was used for illustration. It was found that both data-augmentation and nonaugmentation methods provide accurate and precise point estimation, and that the na\"?ve method resulted in estimates of the transition probabilities with similar bias but larger MSE. The NL method and the EM algorithm in general provide similar results whereas the latter provides conditional expected row margins leading to smaller standard errors.     

Adjusting overall survival for treatment switches: commonly used methods and practical application

In parallel group trials, long‐term efficacy endpoints may be affected if some patients switch or cross over to the alternative treatment arm prior to the event. In oncology trials, switch to the experimental treatment can occur in the control arm following disease progression and potentially impact overall survival. It may be a clinically relevant question to estimate the efficacy that would have been observed if no patients had switched, for example, to estimate ‘real‐life’ clinical effectiveness for a health technology assessment. Several commonly used statistical methods are available that try to adjust time‐to‐event data to account for treatment switching, ranging from naive exclusion and censoring approaches to more complex inverse probability of censoring weighting and rank‐preserving structural failure time models. These are described, along with their key assumptions, strengths, and limitations. Best practice guidance is provided for both trial design and analysis when switching is anticipated. Available statistical software is summarized, and examples are provided of the application of these methods in health technology assessments of oncology trials. Key considerations include having a clearly articulated rationale and research question and a well‐designed trial with sufficient good quality data collection to enable robust statistical analysis. No analysis method is universally suitable in all situations, and each makes strong untestable assumptions. There is a need for further research into new or improved techniques. This information should aid statisticians and their colleagues to improve the design and analysis of clinical trials where treatment switch is anticipated. Copyright © 2013 John Wiley & Sons, Ltd.     

Gender Differences in the Professional Orientations of Protestant Clergy

The literature on gender differences in orientations to work among Protestant clergy has been mixed, but generally points to the hypothesis that female clergy hold fewer career and professional work values than their male counterparts. This expectation flies in the face, however, of other more general population studies that show women and men hold similar work values and orientations to work. Using a national sample of clergy from two Protestant denominations, we test for gender differences in these values and orientations. Consistent with the general population findings, female clergy have professional values and orientations that are just as strong, if not stronger than those of male clergy.     

A Model for Optimization of Biomarker Testing Frequency to Minimize Disease and Cost: Example of Beryllium Sensitization Testing

A common problem with medical surveillance programs using biomarkers is determining the optimal frequency of testing to minimize adverse health effects and cost. In the case of beryllium-exposed workers, frequency of testing for beryllium sensitization may be especially important. Recent studies indicate a lack of dose response for beryllium sensitization, but do support a dose response for the development of chronic beryllium disease (CBD). Though unproven, this implies that early identification of sensitization and immediate removal from exposure may reduce development of CBD. A model is proposed to project the optimal frequency of sensitization testing using the current beryllium lymphocyte proliferation test (BeLPT) to minimize disease-related costs, assuming that a positive BeLPT will precede CBD. Conversion rates for cumulative exposure to disease development were adapted from the literature and used with testing costs and cost of disease estimates in the model. The model was run assuming several test frequency regimes. Results support the use of periodic testing in line with the annual schedule proposed in the Final Chronic Beryllium Disease Prevention Program Rule (1999) following initial testing within three months of first beryllium exposure. The financial and health benefits of reducing the time from exposure to detection of early disease was also explored with the model and demonstrated as a highly desirable characteristic for an alternative test or improved BeLPT. Limitations of the approach are discussed as well as options for adapting this biomarker optimization methodology to consider biomarkers of other exposure-associated diseases.     

Nonverbal behavior and attitudes toward touch

A measure of comfort with touching was found to predict whether or not subjects would volunteer to participate in an experiment involving hugging strangers of both sexes and also to predict levels of personal space. Among those volunteering to give hugs, subjects reporting greater comfort with touch rated those hugs more positively, but this seemed to reflect a readiness to interpret touch positively rather than any clear differences in the nature of the hug actually given. Earlier findings that women report greater comfort with touch than do men were replicated. It was found that reported touch comfort was directly related to such constructs as satisfaction with life, with oneself, and with one's childhood, as well as to self-confidence, assertiveness, socially acceptable self-presentation, and active rather than passive modes of coping with problems. Touch comfort was inversely related to expressed concerns with touches which might reflect status differentials, homosexuality, or negative affective states. It was concluded that the touch comfort construct reflects the degree of one's openness to expressing intimate behavior, the degree to which one adopts an active, rather than passive, interpersonal style, and the degree to which one's social relationships are satisfactory.