Qualitative exploration of the nature of grief-related beliefs and expectations

Societal expectations of grief impact the experience of bereavement. The congruence of societal expectations with current scientific understanding of grief is unknown. Therefore two qualitative studies explored community perceptions of grief. In study one, three small focus groups (N = 9) examined grief-related expectations associated with hypothetical scenarios of bereavement. In study two, the impact of grief-related perceptions on the lived experience of bereavement for 11 individuals was explored through semi-structured interviews. Across both studies, elements of a traditional stage model view of grief were evident, with participants viewing emotional expression of grief as important. An avoidant coping style in the bereaved was considered problematic. Findings of study two suggested that grief-related beliefs may impact the bereavement experience via appraisal of the grief response and willingness to support bereaved individuals. The studies suggested that stage model assumptions in the beliefs of the general population persist, although there was a recognition of diversity in the grief response.     

Missing data: Discussion points from the PSI missing data expert group

The Points to Consider Document on Missing Data was adopted by the Committee of Health and Medicinal Products (CHMP) in December 2001. In September 2007 the CHMP issued a recommendation to review the document, with particular emphasis on summarizing and critically appraising the pattern of drop‐outs, explaining the role and limitations of the ‘last observation carried forward’ method and describing the CHMP's cautionary stance on the use of mixed models. In preparation for the release of the updated guidance document, statisticians in the Pharmaceutical Industry held a one‐day expert group meeting in September 2008. Topics that were debated included minimizing the extent of missing data and understanding the missing data mechanism, defining the principles for handling missing data and understanding the assumptions underlying different analysis methods. A clear message from the meeting was that at present, biostatisticians tend only to react to missing data. Limited pro‐active planning is undertaken when designing clinical trials. Missing data mechanisms for a trial need to be considered during the planning phase and the impact on the objectives assessed. Another area for improvement is in the understanding of the pattern of missing data observed during a trial and thus the missing data mechanism via the plotting of data; for example, use of Kaplan–Meier curves looking at time to withdrawal. Copyright © 2009 John Wiley & Sons, Ltd.     

Reviewing Respite Services: some lessons from the literature

Although the community care reforms raised the profile of respite services for adults with learning disabilities, little is known about the character of respite provision in Britain. This lack of information is compounded by the way the literature about respite is dispersed across user groups and is often restricted to particular types of services or to specific localities. In order to highlight some of the key issues associated with respite, this paper draws on a wide range of literature. Regardless of differences in terms of the service user groups, common themes are identified which are relevant to service planning and provision for adults with learning disabilities. The paper discusses these themes and argues that a break with the traditional notion of respite as primarily a way to relieve carer burden is long overdue. Adopting the perspective of the primary service users affords the opportunity to re-think respite services.     

Failing the Transition from Welfare to Work: Women Chronically Disconnected from Employment and Cash Welfare*

Objectives. Although employment among welfare mothers increased substantially following the 1996 welfare reform, some former welfare recipients failed to find stable employment. We review the extent to which low‐income mothers are without work and cash welfare for long periods of time and seek to understand the correlates of becoming chronically disconnected. Methods. We analyze data from a 1997–2003 panel study of single mothers who received cash welfare in an urban county in Michigan in February 1997. We develop a new measure of the extent to which former recipients are “chronically disconnected” from both employment and cash welfare and estimate regression models of the correlates of this economic outcome. Results. About 9 percent of respondents became chronically disconnected, defined as being without employment and cash welfare during at least one‐quarter of the months during the 79‐month study period. Important correlates of becoming chronically disconnected include having a physical limitation, having a learning disability, using illegal drugs or meeting the diagnostic screening criteria for alcohol dependence, and having no car or driver license. The chronically disconnected are more likely to have lost a job than to have lost welfare benefits and are more economically disadvantaged than those with regular sources of economic support. Conclusions. To reduce the number of women who fail to make a successful transition from welfare to work, more attention should be given to programs and policies that attempt to reconnect disconnected women to regular sources of economic support.