A comparison of different survey techniques for obtaining vital data in A developing country

This article presents estimates of the sources and the extent of observation errors in different questionnaires and methods used to collect birth and death data in the 1961-63 multi-purpose sample survey of Morocco.The questionnaires used in the analysis of the three survey rounds were a list of household members (Rounds1 and 2) and a roll-call (Round3); retrospective death (Rounds1, 2, and 3) and birth (Round 3) queries; a date-of-birth tabulation (Round 2); and a household check-sheet to explain differences between Rounds 1 and 2. All available questionnaires for a given household were brought together and collated to provide several sources of information on births and deaths and a basis for assessing errors.From this analysis, the survey attempted to define the nature and to estimate the frequency of the errors which would have occurred if more restricted types of survey design had been used. Results, based on the period between Rounds 1 and 2, led to three major conclusions.First, if vital data had been collected with a single-round retrospective procedure, gross error (over enumeration plus underenumeration) would have been 17 percent for births and 36 percent for deaths. There is a net error of overenumeration of 3 percent for births (1.4 per1,000population) and 9 percent for deaths (2.3 per1,000population).Second, if two rounds were available to permit a combination of household composition follow-up and a retrospective mortality questionnaire, overenumeration would be almost entirely eliminated and underenumeration would be noticeably reduced. Third, most of the remaining errors of underestimation may be attributed to (1) an estimated number of infants born and deceased between two rounds and missed by all questionnaires, (2) matching failures caused by the absence of adults at Round 1, and (3) matching errors.     

Child sexual abuse in Leeds before and after Cleveland

We report a retrospective cohort study in which clinical and outcome features of 237 cases of child sexual abuse diagnosed by Leeds paediatricians after Cleveland in 1989 were compared with previously published characteristics of 337 children diagnosed by the same paediatricians before Cleveland in 1985 and 1986. Clinical and diagnostic features also were analysed in two subgroups of the 1989 cohort, those for whom there was no case conference and those in whom further abuse was detected at follow-up examination. The number of cases diagnosed annually remained high, and source of referrals and age and sex distribution were similar. Most suspected perpetrators were from within the home in both cohorts. Some clinical features of the 1989 cohort suggested more physically severe abuse. In 1989 fewer children were registered as sexually abused, or were taken into care, and fewer suspected perpetrators were convicted. From the 1989 cohort those children for whom there was no case conference tended to be older, to disclose and were abused less severely by someone outside their home as compared to those for whom a case conference was held. The children in whom further abuse was detected tended to be younger, to not disclose. to be more severely abused by a perpetrator within the home and to be taken into care as compared to those in whom further abuse was not detected. One or more case conferences were held for nearly all of the children in whom further abuse was detected. For most of the 1989 children no evidence was found indicating receipt of mental health services from other than the key social worker. Implications of these findings are discussed in terms of professional and public knowledge and attitudes regarding children's and parental rights and family preservation.     

Risk-taking/gambling-like behavior in preschool children

The types and characteristics of risk-taking or gambling-like behaviors in children are not well understood. Social learning, as one potential etiological factor of risktaking behavior in preschool children, was empirically examined. Prior to playing a risk-taking game, children in the experimental group were exposed to a peer model who had ostensibly won a large prize, whereas control children were exposed to a peer model who had won nothing. Children in the experimental group initiated more risks to win the large prize in the high-risk situation than children in the control group. The results indicated that modeling can enhance risk-taking/gambling-like behavior in young children. Parallels to compulsive gambling in adults, and recommendations for future research were also discussed.The authors wish to thank Melissa Warren and Earlene Goodman for their valuable assistance during the course of this study.Portions of this paper were presented at the meeting of the Western Psychological Association, San Francisco, CA 1991.     

Blunt tools: Performance measurement in policies for health care

Throughout the Western world governments have been obliged to address the tension between the continuously rising cost of publicly-financed health care and the perceived need to restrain aggregate public expenditure. In several countries recent developments have included attempts to apply ‘performance indicators’ to health care programmes. This paper examines the nature of the main US and UK indicators and argues that, though they may help to legitimate expenditure restraint, they will probably tell us little about the effectiveness (or even efficiency) of present practice. Some directions are indicated for an alternative approach to performance measurement.     

The Problem of the Unity of Knowledge in Comte's Philosophy of Science*

Comte's philosophy of science is re-examined from the point of view of the rationalist problematic of the unity of knowledge. It is argued that Comte's attempt to answer this metaphysical problem is the single most important factor determining the final form of his system of positive philosophy, his hierarchy of the sciences, his conception of sociology, and ultimately his positive religion of Humanity. After rejecting the main solutions offered by modern rationalism, Comte provides a subjective unity for the sciences by establishing Humanity as the principle of organization for all knowledge. The article describes the various components of the positive synthesis, their background in the history of ideas, and the contemporary relevance of the problem of unity for logical empiricism and Husserl. Some have said that need for unity expresses the identity of the self; others, that it stands for economy of thought. Possibly, but this is interpretation, psychologically or sociologically tinged. The need for unity is a historical fact and, as such, unresolved. It is also a symbol of science, and its myth. Science is a finely defined and articulated system of symbols; but the ultimate symbol, that of unity, can have no referent. Rather one might say it stands for the totality of the knowable and the unknowable. A confusing situation for the scientific mind, but one it cannot escape. For the conflict at the heart of rationalism is the source of its strength, as long as it lasts. Once the faith is lost, something else has to be found. Under the relentless pressure of social change, with the growing operationalism of physical theory and the metaphysical devastations attendant on Darwinism, the myth of unity could no longer hold. It had to be replaced by unification. But with that the status of science is changed and also that of the scientist. The mirror of nature that reason had endeavored to build up through the ages is shattered, and we look for the first time straight out into an unknown world.     

Family-directed structural therapy

Family-Directed Structural Therapy (FDST) is an approach to family therapy built on traditional concepts of Structural Family Therapy, the Strengths Model, and Group Work Theory. The FDST approach is a goal-oriented, time limited approach that enables the family to identify strengths and areas of concern, as well as to enhance family functioning. This process is facilitated via the use of a common vocabulary and a concretely organized, easily administered FDST Assessment Tool that is completed by adult family members. This article presents the essential features of the FDST approach, including the use and scoring of the FDST Assessment Tool. It concludes with an extensive case example.