The implementation of the healthy cities project in developing countries: lessons from Chittagong

The Chittagong Healthy City Project was carried out in late 1994 in Chittagong, Bangladesh. This paper presents findings of an evaluation of the project based upon internationally generated process indicators related to the institutional aspects of the project. The following issues are discussed with regard to project implementation: the institutional organization of local authorities, institutions' conceptual understanding of the project, formal insertion of the project into public authorities' activities, institutional leadership of the project, central-local relations, the lack of interministerial coordination, the project's office, international projects, and community organization. Giving consideration to these issues may help program planners detect problems in forthcoming projects prior to their implementation.     

Changes in health, mortality, and disability and their impact on long-term care needs

The need for long-term care is driven both by the growth of the elderly population and changes in the age relations of morbidity, disability, and mortality. Data show these relations changed in the U.S. elderly population from 1982 to 1989. Chronic disability prevalence declined between the 1982 and 1989 U.S. National Long Term Care Surveys. Among those impaired, many persons using personal assistance to meet their needs shifted to the use of assisted housing and special equipment. The relation of these trends to other changes--such as the increasing educational level of the elderly population--is examined to estimate how future changes in disability and morbidity may affect the demand for long-term care. Disabilities at specific times as well as their transition rates were examined to determine how long individuals need long-term care. The analyses suggest that, while the amount of long-term care services needed will increase rapidly, the types and amounts of services used by the U.S. elderly population will undergo significant change.     

Treatment issues for survivors of physical and sexual abuse*

Many clients who participate in family therapy have experienced trauma such as physical and sexual abuse in their families of origin. Extensive literature suggests that abusive experiences can result in post-traumatic stress disorders, depression, anxiety, personality disorders, and other long-term effects. Without recognition of the effects that abuse can have on individuals, it is possible to misdiagnose clients or fail to provide them with adequate assistance. This study is an attempt to compare the symptomology of nonabused clients with physically and sexually abused clients using an empirically sound measure. The results demonstrate that the majority of clients who experienced physical and/or sexual abuse in their backgrounds scored in the clinical range on scales from the Millon Clinical Multiaxial Instrument (MCMI) (Millon, 1984). In contrast, clients who did not report abuse had significantly lower scores than the abused clients, and the majority of the nonabused clients scored in the nonclinical range on the scales of the MCMI. Treatment and theoretical implications surrounding the issues of abuse are discussed, and recommendations for marriage and family therapists are provided.     

Strength of attachment: Survey coverage of people with tenuous ties to residences

This article draws on evidence from an exploratory survey of living situations to assess the validity of assumptions about residence and to offer methodological innovations to improve coverage of people with tenuous attachment to households. These innovations include more inclusive probes and questions used to compile the roster of household residents; a review of the places a person stayed the previous few months; and a Residential Attachment scale that measures strength of attachment to households. This scale shows that it takes more probing to list tenuously attached people than most surveys do, suggesting that tenuously attached people are likely to be omitted from the typical survey roster. The Residential Attachment scale is correlated with social and economic participation in households, suggesting that participation is fairly high even among those with tenuous or no residential attachment.     

Understanding the bear movement in gay male culture: redefining masculinity

The bear movement emerged in the gay male culture of the 1980s, but little research on this group has been conducted. The purpose of this qualitative study was to examine the meanings and functions of bear identity. Six bear-identified men participated in intensive interviews investigating this question. Results suggest that men who identify as bears consciously adopt a masculine aesthetic that signifies values of self-acceptance and maturity. The participants described the acceptance of diverse body shapes and ages within the bear community as leading to positive self-esteem and body image. Results are discussed in relation to clinical and advocacy work. They broaden the awareness of the diversity of cultures that exist within the gay community.     

The increase in marital status differences in mortality up to the oldest age in seven European countries, 1990-99

We investigate mortality differentials by marital status among older age groups using a database of mortality rates by marital status at ages 40 and over for seven European countries with 1 billion person-years of exposure. The mortality advantage of married people, both men and women, continues to increase up to at least the age group 85-89, the oldest group we are able to consider. We find the largest absolute differences in mortality levels between marital status groups are at high ages, and that absolute differentials are: (i) greater for men than for women; (ii) similar in magnitude across countries; (iii) increase steadily with age; and (iv) are greatest at older age. We also find that the advantage enjoyed by married people increased over the 1990s in almost all cases. We note that results for groups such as older divorced women need to be interpreted with caution.     

On the Assessment of Monte Carlo Error in Simulation-Based Statistical Analyses

Statistical experiments, more commonly referred to as Monte Carlo or simulation studies, are used to study the behavior of statistical methods and measures under controlled situations. Whereas recent computing and methodological advances have permitted increased efficiency in the simulation process, known as variance reduction, such experiments remain limited by their finite nature and hence are subject to uncertainty; when a simulation is run more than once, different results are obtained. However, virtually no emphasis has been placed on reporting the uncertainty, referred to here as Monte Carlo error, associated with simulation results in the published literature, or on justifying the number of replications used. These deserve broader consideration. Here we present a series of simple and practical methods for estimating Monte Carlo error as well as determining the number of replications required to achieve a desired level of accuracy. The issues and methods are demonstrated with two simple examples, one evaluating operating characteristics of the maximum likelihood estimator for the parameters in logistic regression and the other in the context of using the bootstrap to obtain 95% confidence intervals. The results suggest that in many settings, Monte Carlo error may be more substantial than traditionally thought.     

A simple two-stage design for quantitative responses with application to a study in diabetic neuropathic pain

Two-stage designs offer substantial advantages for early phase II studies. The interim analysis following the first stage allows the study to be stopped for futility, or more positively, it might lead to early progression to the trials needed for late phase II and phase III. If the study is to continue to its second stage, then there is an opportunity for a revision of the total sample size. Two-stage designs have been implemented widely in oncology studies in which there is a single treatment arm and patient responses are binary. In this paper the case of two-arm comparative studies in which responses are quantitative is considered. This setting is common in therapeutic areas other than oncology. It will be assumed that observations are normally distributed, but that there is some doubt concerning their standard deviation, motivating the need for sample size review. The work reported has been motivated by a study in diabetic neuropathic pain, and the development of the design for that trial is described in detail.     

苏联民族学近五年的回顾与前瞻

苏联民族学正处于两个五年计划之交,应当对它前五年的发展作一主要总结,为后五年的民族学研究勾画出基本的发展前景。前五年,苏联民族学保持了传统民族学作为历史知识的一个专门领域的优良成果,在从广泛的历史角度认识和阐述当代世界的族体一民族过程及其发展预测方面,迈出了明显的一步。同时,它和人类学、民俗学、社会学、地理学、人口学、医学、心理学等学科之间,发展了广泛的联系。对民族学理论问题的研究更加重视。研究方法扩展了,丰富了。群众性调查、预测、资料的电脑处理等,尤其得到广泛运用。苏联民族学家从民族学是关于民族(народ—зтнос)·的科学这一观点出发,继续深入研究了本学科的一般理论问题。民族理论的一些重要方面,如确定民族在其他人类共同体中