Assessing the Need for Higher Levels of Care Among Problem Gambling Outpatients

Most treatment for gambling disorder is provided on an outpatient basis. Only a small number of jurisdictions in North America provide higher levels of gambling treatment, such as residential or intensive outpatient (IOP) care, despite the potential need for these services. Further, there appear to be few guidelines for determining appropriate level of gambling treatment. The aim of the present study was to assess the appropriateness of higher levels of problem gambling care among clients receiving outpatient treatment. Problem gamblers and their therapists independently completed questionnaires that assessed the need and desire for residential and IOP treatment. About 42% of problem gambling outpatients noted that they would be “probably” or “definitely” willing to attend residential treatment, and about half indicated they would be equally likely to attend IOP. Therapists recommended about a third of their clients as appropriate for higher levels of care. For both client and therapist assessments, there was a significant association between desire or recommendation for level of treatment and severity of gambling and co-occurring problems. Further, therapist recommendations for level of care were significantly associated with client willingness to attend higher levels of treatment. Our data reveal the potential need for higher levels of care for problem gambling, as evaluated by clients and their therapists. Policy implications for the funding of residential and IOP treatment are discussed.     

The Case Study Method in Psychodynamic Psychology: Focus on Addiction

The case study method has been essential in psychoanalysis and psychodynamic therapy, since it is the only way to describe and explore the deepest levels of the human psyche. Addiction is no more and no less than a particular psychological mechanism, identical at its core to other psychological compulsions, and is therefore best understood and reported by this method that explores the mind in depth. We will discuss the value of the case report method in general and in specific with regard to psychoanalysis and addiction, criticisms raised about this method, and comparisons of it with nomothetic research.     

The Nigerian Civil Registration and Vital Statistics System: Contexts,Institutions, Operation

Civil Registration and Vital Statistics (CRVS) Systems are playing increasing roles in national and global data infrastructure, facilitating the achievement of key developmental goals. The performance of CRVS systems in many developing countries including Nigeria is sub optimal and information on their structure and operations scanty. This paper characterizes the statutory, institutional, and operational elements and social contexts of the Nigerian CRVS System. It includes a context analysis of the system and a review of improvement strategies and interventions. The paper shows that the Nigerian CRVS System is built on viable statutory and institutional platforms—the constitutional enshrinement of: universal, compulsory and continuous civil registration and, a central registration institution—the National Population Commission (NPC). NPC has registration hierarchy and infrastructure deployed at every level of political administration and mechanisms for efficient coordination of registration and production of vital statistics on live-births, deaths and stillbirths amongst other vital events. The major weaknesses of the system include inadequate financing and deployment of registration facilities, conflicting statutes and institutional arrangements for the registration of key events like death and stillbirths. Other weaknesses include intra-organizational conflicts in resource allocation and weak ICT infrastructure within the NPC. These are compounded by overarching contextual issues namely registration unfriendly sociocultural norms, weak national data infrastructure, systemic corruption, poverty and undeveloped civic culture. Domestic initiatives and interventions to improve the system have focused on birth registration, while multilateral interventions have only made a modest impact on the system. Thus, holistic in-country improvement initiatives supported with robust interventions are imperative to overcome weaknesses in the Nigerian CRVS system. However fundamental improvements in CRVS systems in developing countries like Nigeria may likely only follow sustainable solutions to overarching contextual issues especially poor infrastructure, weak institutions, poverty and systemic corruption.     

Heterogeneous climate effects on human migration in Indonesia

We examine the effect of anomalous temperatures, rainfall levels, and monsoon timing on migration outcomes in Indonesia. Using panel data from the Indonesian Family Life Survey and high-resolution climate data, we assess whether intra- and inter-province moves are used as a response to climatic shocks. We evaluate the relative importance of temperature, rainfall, and monsoon timing for migration. Only temperature and monsoon timing have significant effects, and these do not operate in the direction commonly assumed. Estimated effects vary according to individuals’ gender, membership in a farm household, and location. We also analyze climate effects on sources of household income, which highlights the multi-phasic nature of household responses. Results undermine narratives of a uniform global migratory response to climate change and highlight the heterogeneous use of migration as a response to such changes. By extending previous research on environmentally induced migration in Indonesia, we also highlight the sensitivity of estimates to alternative climate and migration measures.     

Estimation of the cumulative incidence function under multiple dependent and independent censoring mechanisms

Competing risks occur in a time-to-event analysis in which a patient can experience one of several types of events. Traditional methods for handling competing risks data presuppose one censoring process, which is assumed to be independent. In a controlled clinical trial, censoring can occur for several reasons: some independent, others dependent. We propose an estimator of the cumulative incidence function in the presence of both independent and dependent censoring mechanisms. We rely on semi-parametric theory to derive an augmented inverse probability of censoring weighted (AIPCW) estimator. We demonstrate the efficiency gained when using the AIPCW estimator compared to a non-augmented estimator via simulations. We then apply our method to evaluate the safety and efficacy of three anti-HIV regimens in a randomized trial conducted by the AIDS Clinical Trial Group, ACTG A5095.     

A penalized likelihood method for nonseparable space–time generalized additive models

In this paper, we study space–time generalized additive models. We apply the penalyzed likelihood method to fit generalized additive models (GAMs) for nonseparable spatio-temporal correlated data in order to improve the estimation of the response and smooth terms of GAMs. The results show that our space–time generalized additive models estimated response and smooth terms reasonable well, and in addition, the mean squared error, mean absolute deviation and coverage intervals improved considerably compared to the classic GAM. An application on particulate matter concentration in the North-Italian region of Piemonte is also presented.     

The Intersubjective Experience of the Physical Body in the Clinical Setting of Eating Disorders

This paper will illuminate one dimension of self-disclosure as it relates to the inescapable presence of the body in treatment, and the female clinician’s ability to bring her physical body into clinical discussions during an encounter with a female client with an eating disorder. Although the clinical literature on eating disorders validates that transference and countertransference issues are particularly powerful, it generally neglects the exploration of these issues specific to the body’s physical presentation. Since body dissatisfaction is increasingly normative for women today, female clinicians need to have a theoretical road map on which to rely when they encounter a shared body experience. Thus, in order to encourage discussions of the therapist’s body in clinical social work practice, the body needs to be situated in a larger theoretical framework within which it can be explained and located; this framework is object relations theory viewed through an intersubjective lens. Concepts from object relations theory will demonstrate the importance of the body in the clinical exchange by highlighting the parallel between Winnicott’s ‘good enough’ mother and the ‘good enough’ therapist’s body. When the therapist is able to judiciously invite discussions of her body into the clinical arena, the client is given the opportunity to move from object relating to object usage. A case presentation exemplifies how this conceptual framework can be applied to clinical social work practice, strengthening the relationship between knowing and doing.     

Measuring Unidimensional Inequality: Practical Framework for the Choice of an Appropriate Measure

Social Indicators Research - Inequality and its analysis have received increasing attention in the literature over the last decades, which has led to the development of a large number of inequality...     

Early socialization of hostile attribution bias: The roles of parental attributions,parental discipline,and child attributes

The goal of this study was to examine child and parent predictors of children's hostile attribution bias (HAB) with a particular focus on exploring the associations between parents’ early attribution of child misbehavior and children's HAB in the transition to school age. Participants were 241 children (118 girls) of middle‐income families who were at risk for school‐age conduct problems. Multi‐method, multi‐informant data were collected on maternal attributions of child misbehavior, parental use of corporal punishment, and child attributes (i.e., verbal IQ, effortful control, theory of mind, and emotional understanding) at 3 years, and child HAB in ambiguous situations at 6 years. Results indicated that mothers’ internal explanations for children's misconduct may either reduce or increase children's later HAB depending on the specific content of attributions, such that mothers’ belief that children misbehave because of their internal state (i.e., emotional state or temperament) was associated with lower levels of child HAB, whereas attributing power‐based motives (i.e., manipulative, controlling intentions) in children was associated with higher levels of HAB. The findings are discussed with respect to appreciating the complexity of parents’ explanations for children's behavior, and considering parental cognition as a potential target for early identification and prevention of child HAB and related problems.     

Abortion Underreporting in Add Health: Findings and Implications

Population Research and Policy Review - Well-documented, large-scale abortion underreporting on U.S. surveys raises questions about the use of abortion self-reports for statistical inference. This...