An ounce of prevention?

While preventive health care is intuitively attractive, both from a disease morbidity and cost of care aspect, it is most effective when the natural history of a disease can be precisely predicted and when there is effective therapy to modify the risk factor. In contrast, if the natural history is uncertain, perhaps due to its multifactorial nature and treatment not entirely effective, there will inevitably be inefficiency in preventive treatment. In this complicated balancing act, the inefficiencies of preventive therapy may be buried beneath the surface, due in part to the method of reporting and perhaps to the enthusiasm for preventive medicine in general. Until we are able to identify more predictive risk factors, there will always be inefficiencies in preventive medicine, and many must be treated for one to benefit. However, the absolute risk reduction and the number needed to treat are useful measures to highlight what can actually be achieved with preventive therapy.     

ABMT and breast cancer: what have we learned?

The debate regarding the efficacy of and insurance coverage for ABMT for breast cancer has been raging since the widespread dissemination of ABMT in the early 1990s. Underlying the debate was the expectation that the results of randomized clinical trials would finally provide scientific data to resolve the frequently emotional controversy. Unfortunately, the results of these eagerly awaited trials failed to show a significant impact in patients with either metastatic breast cancer or those at high risk for metastatic disease. ABMT, as it is now offered, will not provide the breakthrough that was anticipated or a substantial benefit to the majority of patients. Research on ABMT may have evolved from the initial expectation that the trials would confirm a positive to more modest expectations that trials will disprove a negative. The promising results of early trials still require confirmation through randomized controlled trials, and participation in such clinical trials is vitally important.     

Distribution-Free Methods in Regression1

A modification to the least-squares estimating equations in simple linear regression, leading to exact distribution-free inference about slope, is outlined. The modification involves a general residual-transformation iψ and the cases of ψ— sign, rank, and the identity are discussed in some detail. It is also shown how exact inference about individual parameters in regressions with more than one design variable can be carried out by a restricted permutation argument coupled with a suitable design.     

GROUPING PROBLEMS IN DISTRIBUTION-FREE REGRESSION1

In regression models having symmetric errors, exact distribution-free inference about individual parameters may be carried out by grouping observations, eliminating unwanted parameters within groups, and applying distribution free techniques for the symmetric location parameter problem. Models whose errors have identical but not symmetric distributions may obtain symmetry by taking differences between pairs of observations. Both grouping and differencing involve potential efficiency loss. The choice of an optimal scheme to minimize efficiency loss is expressible as a multi–assignment type of problem, whose solutions, exact and approximate, are discussed.     

Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification

The sociology of mental health focuses on the epidemiology, etiology, correlates, and consequences of mental health (i.e., psychiatric disorder and symptoms, psychological distress, and subjective well-being) in an attempt to describe and explain how social structure influences an individual's psychological health. Critical race theory describes and explains iterative ways in which race is socially constructed across micro- and macro-levels, and how it determines life chances implicating the mundane and extraordinary in the continuance of racial stratification (i.e., racism). This paper invoked critical race theory to inform the sociology of mental health's approach to studying race and mental health by conceptualizing five hypothetical mental health problems that could exist because of racial stratification. These problems were: (1) nihilistic tendencies, (2) anti-self issues, (3) suppressed anger expression, (4) delusional denial tendencies, and (5) extreme racial paranoia. Mental health problems such as these and undocumented others can only be recognized given awareness of the social and personal implications of racial stratification.     

Medical Decision Making and Elective Surgery: The Case of Hysterectomy

Review and analyses of three sources of data are presented indicating that 25% of hysterectomies are elective. Annual mortality associated with elective hysterectomy is estimated to be 319, or about 12,122 woman years. Cost-benefit analyses of mortality, life expectancy, morbidity, psychological sequelae, as well as dollar expenditures, reveal high costs and relatively limited benefits. Explanations for this apparent anomaly in decision making are explored and include economic incentives, system structure, sexism, and cancer prophylaxis. Principles of risk perception are discussed in terms of potential biases associated with the cancer prophylaxis motive. It is suggested that physicians' judgements of risk may be more salient to the decision process than those of prospective patients.     

On place utility and the normative allocation of intra-urban migrants

This paper arises out of the fact that place utility, a basic factor in behavioral conceptualizations of migration processes, has not been specified in operational terms. This is done here through a model that assigns intraurban migrants to destination areal units within the city, using a normative linear programming framework based on behavioral considerations. Measures of place utilities for each areal unit and of comparative place utilities for each pair-wise permutation of areal units are provided by the shadow prices of the dual of the linear programming model. The primal of the model allocates migrants so as to maximize the household’s gain from migration. This is measured by the increase in its realized aspirations with respect to a residence site, tempered by the search effort involved in acquiring the site. Implementation of the model utilizes both questionnaire and published data from Cedar Rapids, Iowa for the year 1966 to 1967. Conformity between predictions of the model and real-world characteristics is such that it is concluded that the basic form of the model is sound. It is also concluded that the posited relationships between place utility and behavior in searching for and selecting a new residential site are reasonable and can lead to valuable insights into place utility and its functioning in the intra-urban system. Due to some misallocation of migrant flows, however, we further conclude that the model should be revised into a recursive format for future use.