Multiparameter evidence synthesis in epidemiology and medical decision-making: current approaches

Summary.  Alongside the development of meta-analysis as a tool for summarizing research literature, there is renewed interest in broader forms of quantitative synthesis that are aimed at combining evidence from different study designs or evidence on multiple parameters. These have been proposed under various headings: the confidence profile method, cross-design synthesis, hierarchical models and generalized evidence synthesis. Models that are used in health technology assessment are also referred to as representing a synthesis of evidence in a mathematical structure. Here we review alternative approaches to statistical evidence synthesis, and their implications for epidemiology and medical decision-making. The methods include hierarchical models, models informed by evidence on different functions of several parameters and models incorporating both of these features. The need to check for consistency of evidence when using these powerful methods is emphasized. We develop a rationale for evidence synthesis that is based on Bayesian decision modelling and expected value of information theory, which stresses not only the need for a lack of bias in estimates of treatment effects but also a lack of bias in assessments of uncertainty. The increasing reliance of governmental bodies like the UK National Institute for Clinical Excellence on complex evidence synthesis in decision modelling is discussed.     

The effects of patriarchal systems on beliefs surrounding the Goddess in pre-history and early christianity

This article discusses effects on the Goddess belief by past civilizations through religious and social systems with a focus on shifting images and concepts of the Goddess from pre-history matriarchal social systems, to patriarchal systems in Early Christianity. Additionally, the article addresses how changing interpretations of Goddess images and concepts reflect fundamental changes in religion and social organizations. In adopting a feminist perspective the article ultimately shows the influence and prominence of the Goddess woshipped in Pre-History and Early Christianity. a primary interest in anthropology and religion.     

Myth,allegiances, and the study of social control

That sociology subscribes to certain popular myths and has aligned itself with the welfare of some groups over others complicates research into social control. This is especially so when the research deals with stereotypes and their effects on differential legal treatment. That the discipline has historically taken sides regarding certain commonly held stereotypes and been supportive of certain groups, means that findings that challenge those stereotypes or that are viewed as detrimental to the supported groups are brought into question. Our research on a regulatory mechanism of social control—the Black Book, a list of persons excluded from licensed gaming in Nevada because of their perceived threat to the industry—is illustrative of these complications. Our findings that the Black Book is largely symbolic and is applied discriminatorily challenge not only beliefs in its efficacy but certain myths and allegiances within sociology. That a group sociologically identified with the problem was discriminated against, and that a well-protected group elicited preferential treatment at the hands of regulators who identify with them have been particularly problematic for the acceptance of the findings. We argue here that debunking myth and value neutrality are essential to scientific endeavor and should override such disciplinary tendencies toward the tolerance and protection of some groups over others. Her research has dealt with aspects of culture, organized crime, and social elites. She is currently working on a book on high society and thoroughbred racing. His publications have dealt with issues of labeling and secondary deviation, the role of stereotypes in the legal process, and the legal reaction to corporate crime.     

The Micro System of Deviance in Intimate Relationships*

Deviance in intimate relationships may lie as much within the micro system of such relationships as it does within the personalities of the actors involved. Using a Parsonsian framework, it is argued that the strain of systemically disequilibrated relationships can produce deviant personality adaptations which, in turn, intensify conflict and deviance in those relationships. It is also proposed that a reciprocal quality exists to such maladaptations, with each member of the dyad contributing to the amplification of a stable system of deviant behavior patterns within the relationship. Because the patterns of maladaptive dyads spill over into parent-child relationships, they have implications for understanding intergenerational transmission of deviance between intimates.     

Identity and Boundary Tensions When Educators and Mental Health Professionals Collaborate: Between Wish and Reality

Schools are centers of collaboration in promoting the development and learning of children and adolescents. They seek to develop cultures of collaboration not only within their walls but also among constituencies with similar interests. These efforts, unfortunately, all too often prove frustrating and disappointing to all concerned. Yet, the need for interdisciplinary inquiry is greater today than ever before. This is particularly true considering the complex, diverse, and multifaceted nature of today's schools. No one professional can address all of the problems confronting education, particularly those of urban schools. For decades mental health and education professionals have joined together around their similar interest in promoting children and adolescent development. One such initiative is a program that fosters educators' development. This program, named the Teacher Education Program, began under the auspices of the Chicago Institute for Psychoanalysis and evolved into the Human Development and Learning Program when a partnership was formed with DePaul University's School of Education. From the program's 34-year history, the authors highlight specific tensions they experienced as directors of this collaborative initiative, and how these challenges either were or were not anticipated and/or addressed. The aims are to put a human face on the challenges and struggles encountered in the relationship between education and mental health professionals, and to identify common ground between educational and psychoanalytic theories and practices.     

Health professionals' attitudes and practices in relation to Functional Capacity Evaluations

Functional Capacity Evaluations (FCE's) are part of practice in work injury prevention and rehabilitation, and are designed to define an individual's functional abilities or limitations in the context of safe, productive work tasks. Qualitative research methodology was used to investigate the attitudes and behaviours of health professionals in relation to FCE use. The study aimed to identify why health professionals chose a particular FCE, and to identify what factors influence health professionals' clinical judgements when providing results and recommendations for the individual being assessed. Five health professionals from the Hunter Region of New South Wales, Australia, participated in semi-structured, individual interviews using a phenomenological approach. Following inductive analysis of the data, four themes reflecting participants' attitudes and behaviours of FCE use emerged: i) referrals and expectations, including why and when the assessment is completed ii) outcomes, -- what the results aim to provide iii) workplace/practice/usage issues and iv) skills of the assessor. The results indicate the need for further research on the clinical utility of FCE's. A large scale quantitative study would allow results to be generalised to a wider community of FCE users.     

Factors related to attitudes toward diversity in Australia,Malaysia, and Puerto Rico

In this study, we tested social identity complexity theory (Roccas & Brewer, 2002) in relation to attitudes toward diversity and the associated variables of patriotism, nationalism, religiosity, aggression, and sense of self (well-being) in a cross-cultural study of 398 Malaysian, 239 Australian, and 201 Puerto Rican students. Puerto Ricans reported the most positive attitudes toward diversity, followed by Australians, and finally Malaysians. For Puerto Ricans, pro-diversity attitudes were predicted by a positive correlation with constructive patriotism and a negative correlation with blind patriotism. For Australians, pro-diversity attitudes were predicted by a positive association with constructive patriotism, a negative association with traditional nationalism, and a negative association with physical aggression. For Malaysians, pro-diversity attitudes were predicted by positive relationships with all of the following variables: constructive patriotism, traditional nationalism, verbal aggression, hostility, and the need to bolster self through idealizing others. These results support social identity complexity theory and partially support associated predictions for Australians, Puerto Ricans, and some of the predictions for Malaysians. The results are explained in terms of local cultural contexts that may not easily be understood by a simple understanding of the variables that were measured.     

Endless Pressure: Life on a Low Income in Austere Times

Much has been written that details the decline in living standards following the ‘credit crunch’ in the UK. It remains that we understand to a lesser degree the lived reality of poverty through the Great Recession and into the era of austerity. This article draws on testimonies of 62 participants from low income households conducted in three different areas of the UK during 2012–13 to document the pressures that this period brought to bear on these households. According to these testimonies, the experience of poverty intensified in key respects: first, participants reported feeling, more than ever before, that they were ‘existing, rather than living’ due to the meagre budgets they were forced to live on; second, the precarious nature of work and social security contributed to a sense of insecurity that was all pervasive in our participants' lives; third, due to the pejorative political rhetoric and media coverage of poverty, our participants felt that their lives were placed under increased scrutiny which deleteriously impacted their wider relationships and sense of belonging. Our analysis demonstrates the profound consequences for those living on low incomes of the continued shift to residual forms of state welfare and the increased reliance on the ‘Big Society’ as a means to deal with the pressures identified in this article.     

Psychological Distress,Couple Interactions,and Parenting: A Dyadic Analysis of African American Couples

Parental depression is a well‐established risk factor for couple conflict and ineffective or hostile parenting (M. C. Lovejoy, P. A. Graczyk, E. O'Hare, & G. Neuman, 2000; L. M. Papp, M. C. Goeke‐Morey, & E. M. Cummings, 2007). Although research suggests that caregiver depression may impact parenting indirectly via increased conflict between couples (e.g., R. D. Conger et al., 2002), few studies take into account the behaviors of both caregivers in exploring these relations. The goal of the current study is to employ an actor–partner mediator model to examine the complex relations among psychological distress, negative couple interactions, and parenting. Using a sample of 162 African American couples with children, we find evidence that the psychological distress of each caregiver has an effect on couple interactions for both men and women. The effects from each caregivers' distress to parenting are mainly indirect through the interactional behaviors of the mother toward the father, consistent with the father vulnerability hypothesis (e.g., E. M. Cummings, M. Goeke‐Morey, & J. Raymond, 2004).