Overcoming the ‘tyranny of the urgent’: integrating gender into disease outbreak preparedness and response

ABSTRACT

This article contributes to discussions on the gender dimensions of disease outbreaks, and preparedness policies and responses, by providing a multi-level analysis of gender-related gaps, particularly illustrating how the failure to challenge gender assumptions and incorporate gender as a priority at the global level has national and local impacts. The implications of neglecting gender dynamics, as well as the potential of equity-based approaches to disease outbreak responses, is illustrated through a case study of the Social Enterprise Network for Development (SEND) Sierra Leone, a non-government organisation (NGO) based in Kailahun, during the Ebola outbreak.     

Off‐Time Pubertal Timing Predicts Physiological Reactivity to Postpuberty Interpersonal Stress

We investigated associations between retrospectively assessed timing of pubertal development, interpersonal interactions, and hypothalamic–pituitary–adrenal axis reactivity to an interpersonal stress task in 110 young adult women. Participants provided salivary cortisol samples at points prior and subsequent to a video‐taped conflict discussion with their romantic partner. Participants also provided subjective global ratings of their discussion on dimensions of conflict and support. For earlier developing girls, higher levels of interpersonal conflict were associated with greater physiological stress in anticipation of the discussion task and less physiological recovery following the discussion. In contrast, for later developing girls, low levels of conflict were associated with greater anticipatory stress and less physiological recovery. These findings have implications for understanding the influence of off‐time pubertal development on the lifetime development of young women.     

Asymmetric Forecast Densities for U.S. Macroeconomic Variables from a Gaussian Copula Model of Cross-Sectional and Serial Dependence

Most existing reduced-form macroeconomic multivariate time series models employ elliptical disturbances, so that the forecast densities produced are symmetric. In this article, we use a copula model with asymmetric margins to produce forecast densities with the scope for severe departures from symmetry. Empirical and skew t distributions are employed for the margins, and a high-dimensional Gaussian copula is used to jointly capture cross-sectional and (multivariate) serial dependence. The copula parameter matrix is given by the correlation matrix of a latent stationary and Markov vector autoregression (VAR). We show that the likelihood can be evaluated efficiently using the unique partial correlations, and estimate the copula using Bayesian methods. We examine the forecasting performance of the model for four U.S. macroeconomic variables between 1975:Q1 and 2011:Q2 using quarterly real-time data. We find that the point and density forecasts from the copula model are competitive with those from a Bayesian VAR. During the recent recession the forecast densities exhibit substantial asymmetry, avoiding some of the pitfalls of the symmetric forecast densities from the Bayesian VAR. We show that the asymmetries in the predictive distributions of GDP growth and inflation are similar to those found in the probabilistic forecasts from the Survey of Professional Forecasters. Last, we find that unlike the linear VAR model, our fitted Gaussian copula models exhibit nonlinear dependencies between some macroeconomic variables. This article has online supplementary material.     

Investigating impacts of complex sampling on latent growth curve modelling

We investigate the impacts of complex sampling on point and standard error estimates in latent growth curve modelling of survey data. Methodological issues are illustrated with empirical evidence from the analysis of longitudinal data on life satisfaction trajectories using data from the British Household Panel Survey, a national representative survey in Great Britain. A multi-process second-order latent growth curve model with conditional linear growth is used to study variation in the two perceived life satisfaction latent factors considered. The benefits of accounting for the complex survey design are considered, including obtaining unbiased both point and standard error estimates, and therefore correctly specified confidence intervals and statistical tests. We conclude that, even for the rather elaborated longitudinal data models that were considered, estimation procedures are affected by variance-inflating impacts of complex sampling.     

Employment status of women with disabilities from the Behavioral Risk Factor Surveillance Survey (1995-2002)

Among working aged adults (18-64) with disabilities, three out of 10 (32%) work full or part-time, compared to eight out of 10 (81%) of those without disabilities [9]. In addition, 24.7% of women with a severe disability and 27.8% of men with a severe disability are employed, while women with a non-severe disability have an employment rate of 68.4% and men with a non-severe disability have an employment rate of 85.1% [14]. This study examined data from the Behavioral Risk Factor Surveillance Survey from 1995-2002 to determine whether or not disparities exist in the rate of unemployment for women with disabilities, compared to men with disabilities and women and men without disabilities. In addition, regression analysis looked at the how disability and gender predict the outcome of unemployment. Results showed that there has been essentially no change with regard to employment for any of these populations. In addition, disability and gender were found to be the strongest predictors of unemployment for women with disabilities. Possible explanations were discussed as to the reasons for the results and issues were presented for future research.     

Experiences of homelessness by people seeking asylum in Australia: A review of published and “grey” literature

This review examines the current published and “grey” literature relating to the experiences of homelessness by people seeking asylum within Australia. While many people seeking asylum have experienced homelessness during their flight, inadequate and unaffordable housing are a feature of the settlement experience for a large number of new arrivals to Australia, putting at risk their successful settlement. This study aims to explore the factors influencing access to stable housing. A systematic review of the academic literature and a search of the grey literature identified 11 articles and 20 documents related to homelessness and people seeking asylum in Australia. The academic literature included a variety of methods and approaches to the investigation of the experience of homelessness in Australia. The grey literature was more practice based, including evaluation and research reports, submissions, and newsletters. Findings suggest that experiences of homelessness are multifaceted and have a range of influences, including policy, financial stress, lack of access to education and employment, and a lack of affordable and suitable housing. Any solutions to address homelessness need to be similarly diverse. Discrimination from real estate agents and employers was also identified as a barrier to housing for many people seeking asylum, an issue that will need to be addressed at a systematic level. The lack of research published in the academic literature means that although there may be some programmes or solutions operating in the community, as demonstrated in the grey literature, this information is not being shared beyond organisation websites or subscriber lists, resulting in a lack of coherency or sharing of solutions. This review highlights the need for further attention to the factors influencing homelessness in asylum seekers, the experience of homelessness, and how these can be addressed by government and non-government led strategies and policy development.     

Exploring the relation between maternal mind‐mindedness and children’s symbolic play: A longitudinal study from 6 to 18 months

Relations between mothers’ mind‐mindedness (appropriate attunement to their infants’ internal states) at 6 and 12 months and infants’ early symbolic play during infant–mother pretense at 12 and 18 months were investigated in a sample of 43 mothers and infants. Mothers’ appropriate mind‐related comments were associated with average level, length, complexity, and maturity level of symbolic play. Specific sub‐categories of appropriate mind‐related comments were identified as independent predictors of children's symbolic play. Appropriate comments about desires and cognitions at 6 months were associated with average level and length of episodes, as well as with maturity level of symbolic play at 12 months. Longitudinal stability in the appropriateness and content of mothers’ mind‐related comments was also investigated. The results are discussed in terms of the proposal that attunement to specific types of internal state should vary as a function of infant age in order to index mind‐mindedness.     

Graphical representation of survival curves in the presence of time-dependent categorical covariates with application to liver transplantation

Graphical representation of survival curves is often used to illustrate associations between exposures and time-to-event outcomes. However, when exposures are time-dependent, calculation of survival probabilities is not straightforward. Our aim was to develop a method to estimate time-dependent survival probabilities and represent them graphically. Cox models with time-dependent indicators to represent state changes were fitted, and survival probabilities were plotted using pre-specified times of state changes. Time-varying hazard ratios for the state change were also explored. The method was applied to data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Survival curves showing a ‘split’ at a pre-specified time t allow for the qualitative comparison of survival probabilities between patients with similar baseline covariates who do and do not experience a state change at time t. Time since state change interactions can be visually represented to reflect changing hazard ratios over time. A2ALL study results showed differences in survival probabilities among those who did not receive a transplant, received a living donor transplant, and received a deceased donor transplant. These graphical representations of survival curves with time-dependent indicators improve upon previous methods and allow for clinically meaningful interpretation.