Work and non-work factors as perceived causes of symptoms of psychological strain

Two studies are reported in which the respondents were asked to attribute causes to their experienced symptoms of stress as measured by the General Health Questionnaire. The results show that most respondents can do this, that there are differences in attributions by symptoms, and that the pattern of attributions is similar for two different occupational groups, even though the level of symptomology is higher for nurses than for laboratory workers. It is argued that this simple addition to symptom questionnaires might have useful diagnostic value, but that further research with different populations and other symptoms is desirable.     

What Role Has the Law Played in Getting Rid of Racism in the Lives of Children?

SUMMARY. It is only relatively recently that a detailed knowledge of how the Race Relations Act 1976 works in practice has made it possible to use it more effectively - to eliminate that element of racism - discrimination. The later Children Act 1989 and its accompanying Guidance, in requiring a heal authority, (when making a decision about a child for whom it is responsible), to take account of the child's religious persuasion, racial origin and cultural and linguistic background establishes a framework to promote equality of opportunity and to counter the learning of racist attitudes. This paper attempts to identify the role of these two Acts in getting rid of racism in children's lives. Knowledge of both Acts will empower parents and professionals' to be able to challenge discrimination and identify anti-racist practice.     

Post-traumatic stress disorder and health-related quality of life in female victims of intimate partner violence

The association between post-traumatic stress disorder (PTSD) and health-related quality of life (QOL) in female victims of intimate partner violence (IPV) was examined. The Short-Form Health Survey (SF-36) was used to evaluate health-related QOL. IPV victims with PTSD (IPV/PTSD+; n = 18), IPV victims without PTSD (IPV/PTSD-; n = 22), and a non-abused control group (NA; n = 30) were compared. Multiple Analyses of Covariance (covarying for socioeconomic status and age) indicated that the three groups scored significantly differently on health-related QOL, and the IPV/PTSD- group was significantly more impaired than the NA group. IPV/PTSD+ subjects were significantly more impaired than IPV/PTSD- subjects on physical functioning, mental health, vitality, role limitations due to emotional health, and social functioning. Multiple regression analyses indicated that PTSD severity was a significant statistical predictor of SF-36 mental health composite scores (but not of physical health composite scores), after controlling for depressive symptomatology and extent of physical and psychological abuse.     

Practice Guidelines In Child Custody Evaluations for Licensed Clinical Social Workers

Child custody evaluations and decisions are often complicated and emotionally charged. The following guidelines are offered as a framework for clinical social workers who are asked by the judicial system to undertake these evaluations. The historical background of child custody and the theoretical considerations that have guided the courts are reviewed. The traditional areas of consideration and the empirical data related to these areas are examined. The guidelines present pertinent information regarding ethical considerations, parent–child relationship, parenting style, gender issues, parental conflict, parental alienation, domestic violence, race, religion, sexual preferences, geography, parental psychopathology, substance abuse, child’s preference, physical health of the child, and behavioral health of the child. A format for the evaluation process is described and includes the role of the clinician, confidentiality, fees, and review of documents, interviewing, home visits, psychological testing, and the actual written report. Making recommendations to the court regarding child custody is an area of practice that clinical social workers encounter in ever-increasing numbers. Clinical social workers are called upon to give recommendations regarding child custody in neglect or abuse cases, in termination of parental rights proceedings, and in the area divorce and of guardianship. In an effort to provide clinicians with scientifically grounded parameters for rendering these recommendations, the following guidelines are recommended. These guidelines provide a framework of scientific principles, along with established and accepted clinical practice, to enhance the practitioner’s decision making in these challenging and complicated cases. The guidelines are specifically designed for clinical social workers doing custody evaluations in cases of marital divorce and are restricted to that area of practice.     

Globalization and the German model of capitalism – erosion or survival?

The German business system has been regarded as a particularly tightly coupled system, with embeddedness of even multinational companies (MNCs) in their home base as particularly deep. A study of the impact of companies' changing internationalization, if not globalization, strategies is therefore especially suited to test competing claims about their effects on the German business system. Are we experiencing an erosion of this system, an adaptation in a largely path‐dependent way, or even a greater specialization and stronger crystallization of the German business system? To investigate these questions, the paper examines a small number of German MNCs in their domestic and international context. More particularly, the work focuses on whether and how their emergent globalization activities affect the reproduction or erosion of the three institutional complexes which shape the factors of production: the financial system; the innovation system; and the industrial relations system. The paper concludes that a new type of transformation – hybridization – is emerging. It is regarded as a consequence of German companies' growing integration into a global economic system.     

Handling drop-out in longitudinal clinical trials: a comparison of the LOCF and MMRM approaches

This study compares two methods for handling missing data in longitudinal trials: one using the last-observation-carried-forward (LOCF) method and one based on a multivariate or mixed model for repeated measurements (MMRM). Using data sets simulated to match six actual trials, I imposed several drop-out mechanisms, and compared the methods in terms of bias in the treatment difference and power of the treatment comparison. With equal drop-out in Active and Placebo arms, LOCF generally underestimated the treatment effect; but with unequal drop-out, bias could be much larger and in either direction. In contrast, bias with the MMRM method was much smaller; and whereas MMRM rarely caused a difference in power of greater than 20%, LOCF caused a difference in power of greater than 20% in nearly half the simulations. Use of the LOCF method is therefore likely to misrepresent the results of a trial seriously, and so is not a good choice for primary analysis. In contrast, the MMRM method is unlikely to result in serious misinterpretation, unless the drop-out mechanism is missing not at random (MNAR) and there is substantially unequal drop-out. Moreover, MMRM is clearly more reliable and better grounded statistically. Neither method is capable of dealing on its own with trials involving MNAR drop-out mechanisms, for which sensitivity analysis is needed using more complex methods.     

Analysis of exacerbation rates in asthma and chronic obstructive pulmonary disease: example from the TRISTAN study

Recurrent events in clinical trials have typically been analysed using either a multiple time-to-event method or a direct approach based on the distribution of the number of events. An area of application for these methods is exacerbation data from respiratory clinical trials. The different approaches to the analysis and the issues involved are illustrated for a large trial (n = 1465) in chronic obstructive pulmonary disease (COPD). For exacerbation rates, clinical interest centres on a direct comparison of rates for each treatment which favours the distribution-based analysis, rather than a time-to-event approach. Poisson regression has often been employed and has recently been recommended as the appropriate method of analysis for COPD exacerbations but the key assumptions often appear unreasonable for this analysis. By contrast use of a negative binomial model which corresponds to assuming a separate Poisson parameter for each subject offers a more appealing approach. Non-parametric methods avoid some of the assumptions required by these models, but do not provide appropriate estimates of treatment effects because of the discrete and bounded nature of the data.     

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.